Provider Demographics
NPI:1376584425
Name:JONES, LAVINIA D (CRNA)
Entity Type:Individual
Prefix:
First Name:LAVINIA
Middle Name:D
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 LAKELAND DR STE 1060
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8016
Mailing Address - Country:US
Mailing Address - Phone:601-420-5810
Mailing Address - Fax:601-420-5811
Practice Address - Street 1:901 JACKSON ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2519
Practice Address - Country:US
Practice Address - Phone:601-420-5810
Practice Address - Fax:604-420-5811
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906111363L00000X, 363LP0808X
MSR857248367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00695430OtherMEDICARE RAILROAD
MS00126795Medicaid
MS00126795Medicaid
MSP6050Medicare UPIN