Basic Information
| Provider Information | |||||||||
| NPI: | 1699282988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21890 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5029070356 | ||||||||
| FaxNumber: | 5029199780 | ||||||||
| Practice Location | |||||||||
| Address1: | 9390 BUNSEN PKWY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402203789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8333582278 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2018 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 3011837 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 000001354703 | 01 | ANTHEM PROVIDER ID NUMBER | OTHER | 6697404 | 01 | UNITED HEALTHCARE PROVIDER ID NUMBER | OTHER | 7100513560 | 05 | KY | MEDICAID | 300035863 | 05 | IN | MEDICAID | CS2010400216 | 01 | CARESOURCE PROVIDER ID NUMBER | OTHER | PDZ000000439578 | 01 | KY | AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER | OTHER |