Provider Demographics
NPI:1205370590
Name:JONES, MARY ANN
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:STILLWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1964 BROOKS RD
Mailing Address - Street 2:1964 BROOKS RD
Mailing Address - City:BUFFALO
Mailing Address - State:KY
Mailing Address - Zip Code:42716-8124
Mailing Address - Country:US
Mailing Address - Phone:270-748-0539
Mailing Address - Fax:
Practice Address - Street 1:1964 BROOKS RD
Practice Address - Street 2:1964 BROOKS RD
Practice Address - City:BUFFALO
Practice Address - State:KY
Practice Address - Zip Code:42716-8124
Practice Address - Country:US
Practice Address - Phone:270-748-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator