Provider Demographics
NPI:1033177654
Name:JONES, VICKIE (CFNP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
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 1:585 INTERSTATE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3190
Mailing Address - Country:US
Mailing Address - Phone:931-728-9000
Mailing Address - Fax:931-728-2726
Practice Address - Street 1:585 INTERSTATE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3190
Practice Address - Country:US
Practice Address - Phone:931-728-9000
Practice Address - Fax:931-728-2726
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4102290OtherBCBS
TN3344220Medicaid
TN4102290OtherBCBS
TN3344112Medicare ID - Type Unspecified