Provider Demographics
NPI:1376103408
Name:JONES, DENEITRA (CNA AN LPN)
Entity Type:Individual
Prefix:MRS
First Name:DENEITRA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:CNA AN LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BAINBRIDGE XING
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-6031
Mailing Address - Country:US
Mailing Address - Phone:601-594-6449
Mailing Address - Fax:769-300-0099
Practice Address - Street 1:131 BAINBRIDGE XING
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-6031
Practice Address - Country:US
Practice Address - Phone:601-594-6449
Practice Address - Fax:769-300-0099
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS83-4624676376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS83-4624676Medicaid