Provider Demographics
NPI:1215562947
Name:JONES, JESSICA SHALAI
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SHALAI
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 1:5419 HIGH JUMP DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3439
Mailing Address - Country:US
Mailing Address - Phone:615-586-1836
Mailing Address - Fax:
Practice Address - Street 1:309 QUECREEK CIR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6849
Practice Address - Country:US
Practice Address - Phone:615-355-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27388363LF0000X
TNF02201191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ081743Medicaid
TN6423967OtherBCBS TN