Provider Demographics
NPI:1114090149
Name:JONES, STACEY
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3838
Mailing Address - Country:US
Mailing Address - Phone:334-566-9800
Mailing Address - Fax:334-566-3700
Practice Address - Street 1:801 S FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3838
Practice Address - Country:US
Practice Address - Phone:334-566-9800
Practice Address - Fax:334-566-3700
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1074574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL05151412OtherBLUECROSS
AL891004000Medicaid
AL05151412OtherBLUECROSS
ALP47299Medicare UPIN