Provider Demographics
NPI:1164871877
Name:JONES, ALISHA (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 RIVER TRACE DR
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-5556
Mailing Address - Country:US
Mailing Address - Phone:228-324-3937
Mailing Address - Fax:
Practice Address - Street 1:730 E BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-6259
Practice Address - Country:US
Practice Address - Phone:228-214-3319
Practice Address - Fax:228-214-3272
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSDL1669133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered