Provider Demographics
NPI:1063032704
Name:JONES, DESTINEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DESTINEE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:DESTINEE
Other - Middle Name:
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:15694 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOWN CREEK
Mailing Address - State:AL
Mailing Address - Zip Code:35672-4026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 S JACKSON HWY STE 100
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5769
Practice Address - Country:US
Practice Address - Phone:256-314-2550
Practice Address - Fax:256-314-2551
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-169115363LA2200X, 363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care