Provider Demographics
NPI:1083687586
Name:JONES MATHEUS, KERI J (WHNP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:J
Last Name:JONES MATHEUS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SUGAR SAND LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7482
Mailing Address - Country:US
Mailing Address - Phone:850-534-4170
Mailing Address - Fax:850-534-4174
Practice Address - Street 1:45 SUGAR SAND LANE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7482
Practice Address - Country:US
Practice Address - Phone:850-534-4170
Practice Address - Fax:850-534-4174
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850667363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03752321Medicaid
MS500001525Medicare PIN
MS03752321Medicaid