Provider Demographics
NPI:1083981211
Name:JONES, JESSICA R (MED)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2605
Mailing Address - Country:US
Mailing Address - Phone:270-282-2202
Mailing Address - Fax:270-971-4116
Practice Address - Street 1:1183 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2605
Practice Address - Country:US
Practice Address - Phone:270-282-2202
Practice Address - Fax:270-971-4116
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid