Basic Information
| Provider Information | |||||||||
| NPI: | 1407963663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2930 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462062930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444689496 | ||||||||
| FaxNumber: | 8556301300 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 E. THIRD ST | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236028400 | ||||||||
| FaxNumber: | 4236028401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 10/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN144680 | TN | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN154653 | GA | N | Nursing Service Providers | Registered Nurse | 367500000X | APN12514 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 009911702 | 05 | AL | MEDICAID | P00443433 | 01 | TN | RAILROAD MEDICARE | OTHER | 3638259 | 05 | TN | MEDICAID | 8052758 | 05 | NC | MEDICAID | 883490704A | 05 | GA | MEDICAID | N382696 | 01 | GA | WELLCARE (GA MEDICAID) | OTHER | 4158768 | 01 | TN | BLUE CROSS BLUE SHIELD TN | OTHER |