Provider Demographics
NPI:1073285433
Name:JONES, MAMA L (FNP)
Entity Type:Individual
Prefix:
First Name:MAMA
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAMA
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:601 OLD PAINT RD
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8496
Mailing Address - Country:US
Mailing Address - Phone:913-484-9079
Mailing Address - Fax:
Practice Address - Street 1:601 OLD PAINT RD
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8496
Practice Address - Country:US
Practice Address - Phone:913-484-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021040198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2021040198OtherNURSE PRACTITIONER LICENSE