Provider Demographics
NPI:1043786569
Name:JONES, GRACE-MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:GRACE-MARIE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 ENDICOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-3499
Mailing Address - Country:US
Mailing Address - Phone:817-838-8229
Mailing Address - Fax:
Practice Address - Street 1:5201 ENDICOTT AVENUE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:817-838-8229
Practice Address - Fax:609-631-5984
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341648164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse