Provider Demographics
NPI:1225034267
Name:JONES, JO ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JO ANN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:270-780-0478
Practice Address - Street 1:1065 ASHLEY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3400
Practice Address - Country:US
Practice Address - Phone:270-781-5111
Practice Address - Fax:270-780-0478
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP747207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50008663OtherPASSPORT
KY000000358328OtherANTHEM
KYP00289739OtherRAILROAD MEDICARE
KY64097314Medicaid
KY0707012Medicare PIN
KY000000358328OtherANTHEM
KY1307410Medicare PIN