Provider Demographics
NPI:1053482661
Name:JONES, CARMEN ANN (CFNP)
Entity Type:Individual
Prefix:PROF
First Name:CARMEN
Middle Name:ANN
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 1:502 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47907-2069
Mailing Address - Country:US
Mailing Address - Phone:765-494-0311
Mailing Address - Fax:765-494-6339
Practice Address - Street 1:901 PRINCE WILLIAM RD
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1758
Practice Address - Country:US
Practice Address - Phone:765-564-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001221A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200351840Medicaid
IN232230JJJJMedicare PIN