Provider Demographics
NPI:1073571147
Name:JONES, JIMMY LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 FRANKLIN SQUARE DR
Mailing Address - Street 2:2 NORTH
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3901
Mailing Address - Country:US
Mailing Address - Phone:443-777-7179
Mailing Address - Fax:443-777-8242
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:2 NORTH
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-7179
Practice Address - Fax:443-777-8242
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR106481367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD203400000Medicaid
MDR106481OtherCRNA LICENSE
MD360L163WMedicare ID - Type Unspecified