Provider Demographics
NPI:1275204463
Name:JONES, KAYSHAWN JASMINE
Entity Type:Individual
Prefix:MISS
First Name:KAYSHAWN
Middle Name:JASMINE
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 1:200 INNOVATION WAY APT 6
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-8148
Mailing Address - Country:US
Mailing Address - Phone:786-267-3151
Mailing Address - Fax:
Practice Address - Street 1:200 INNOVATION WAY APT 6
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-8148
Practice Address - Country:US
Practice Address - Phone:786-267-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJ520510928380253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care