Provider Demographics
NPI:1003338385
Name:JONES, MARY SUZANNE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SUZANNE
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:SAZANNE
Other - Last Name:MCCUTCHEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP--BC
Mailing Address - Street 1:201 EUGENE DR
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601-2878
Mailing Address - Country:US
Mailing Address - Phone:573-915-1180
Mailing Address - Fax:
Practice Address - Street 1:2727 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-3430
Practice Address - Country:US
Practice Address - Phone:573-358-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017014056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily