Provider Demographics
NPI:1003865551
Name:JONES, DENISE L (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:TN
Mailing Address - Zip Code:37142-2248
Mailing Address - Country:US
Mailing Address - Phone:585-409-0151
Mailing Address - Fax:
Practice Address - Street 1:605 JOEL DRIVE
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29229363L00000X
TXAP116450363LF0000X
NY334373363LF0000X
NM03560363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6089Medicare ID - Type Unspecified
NYQ37440Medicare UPIN