Provider Demographics
NPI:1326457557
Name:JONES, RUSSELL D (NP)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:D
Last Name:JONES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 S FREMONT AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2295
Mailing Address - Country:US
Mailing Address - Phone:417-820-3500
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT AVE STE 350
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2295
Practice Address - Country:US
Practice Address - Phone:417-820-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810608363LA2100X
COC-APN.0000647-C-NP363LF0000X
MO2021006449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care