Provider Demographics
NPI:1366845026
Name:JONES, CHARRISE
Entity Type:Individual
Prefix:MRS
First Name:CHARRISE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:REESE
Other - Middle Name:JONES
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2280 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1010
Mailing Address - Country:US
Mailing Address - Phone:314-972-1380
Mailing Address - Fax:314-972-1380
Practice Address - Street 1:2280 SOMERSET DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1010
Practice Address - Country:US
Practice Address - Phone:314-972-1380
Practice Address - Fax:314-972-1380
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor