Provider Demographics
NPI:1336132927
Name:JONES, CHERYLL ANN (ARNP CPNP)
Entity Type:Individual
Prefix:
First Name:CHERYLL
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:ARNP CPNP
Other - Prefix:
Other - First Name:CHERYLL
Other - Middle Name:ANN
Other - Last Name:MCLANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:931 PENNSYLVANIA AVE
Mailing Address - Street 2:OTTUMWA PEDIATRICS
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2138
Mailing Address - Country:US
Mailing Address - Phone:641-684-3000
Mailing Address - Fax:641-684-2469
Practice Address - Street 1:317 VANNESS AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1434
Practice Address - Country:US
Practice Address - Phone:641-682-8145
Practice Address - Fax:641-682-8857
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA043448163W00000X
IAC043448363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S99688Medicare UPIN
IA16060Medicare PIN