Provider Demographics
NPI:1417678277
Name:JONES, KIERAN (NP)
Entity Type:Individual
Prefix:
First Name:KIERAN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 WILSHIRE BLVD APT 324
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5778
Mailing Address - Country:US
Mailing Address - Phone:203-928-9388
Mailing Address - Fax:
Practice Address - Street 1:5757 WILSHIRE BLVD STE 475
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3632
Practice Address - Country:US
Practice Address - Phone:323-607-2895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027640363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner