Provider Demographics
NPI:1073505509
Name:JONES, JACKLYN S (ARNP)
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:S
Last Name:JONES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANEY
Mailing Address - State:KS
Mailing Address - Zip Code:67333-1462
Mailing Address - Country:US
Mailing Address - Phone:620-879-2182
Mailing Address - Fax:620-879-2246
Practice Address - Street 1:218 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANEY
Practice Address - State:KS
Practice Address - Zip Code:67333-1462
Practice Address - Country:US
Practice Address - Phone:620-879-2182
Practice Address - Fax:620-879-2246
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner