Provider Demographics
NPI:1366484461
Name:JONES, GARY (FNP)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:2631 CUNNINGHAM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1543
Mailing Address - Country:US
Mailing Address - Phone:417-627-8967
Mailing Address - Fax:417-627-8951
Practice Address - Street 1:2817 MCCLELLAND BLVD
Practice Address - Street 2:SUITE 224
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1629
Practice Address - Country:US
Practice Address - Phone:417-781-5387
Practice Address - Fax:417-781-7174
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO139525363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q01762Medicare UPIN