Provider Demographics
NPI:1467426130
Name:JONES, STACEY NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:N
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:509 W TIDWELL
Mailing Address - Street 2:#100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091
Mailing Address - Country:US
Mailing Address - Phone:713-694-6447
Mailing Address - Fax:713-694-6593
Practice Address - Street 1:509 W TIDWELL
Practice Address - Street 2:#100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091
Practice Address - Country:US
Practice Address - Phone:713-694-6447
Practice Address - Fax:713-694-6593
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00359MMedicare ID - Type Unspecified
H27443Medicare UPIN