Provider Demographics
NPI:1184648404
Name:JONES, CLARISSA (ACNP)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-8319
Practice Address - Street 1:3800 W 203RD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1184
Practice Address - Country:US
Practice Address - Phone:708-679-2670
Practice Address - Fax:708-503-3260
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005018363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209325Medicare ID - Type Unspecified