Provider Demographics
NPI:1235159112
Name:JONES, KIMBERLY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
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 1:2530 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3153
Mailing Address - Country:US
Mailing Address - Phone:318-212-5781
Mailing Address - Fax:318-212-5785
Practice Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP STE 114
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3153
Practice Address - Country:US
Practice Address - Phone:318-212-5781
Practice Address - Fax:318-212-5785
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.11779R207RP1001X
LA11779R2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1692255Medicaid
LAG60645Medicare UPIN
LA1692255Medicaid