Provider Demographics
NPI:1457320483
Name:JONES, RUSSELL A (FNP)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:A
Last Name:JONES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-3209
Mailing Address - Country:US
Mailing Address - Phone:518-314-6849
Mailing Address - Fax:
Practice Address - Street 1:85 PLAZA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6438
Practice Address - Country:US
Practice Address - Phone:518-324-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333991-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ02210Medicare UPIN