Provider Demographics
NPI:1508307950
Name:JONES, SHELLEY ELIZABETH (CSFA)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ELIZABETH
Last Name:JONES
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-9102
Mailing Address - Country:US
Mailing Address - Phone:270-618-1115
Mailing Address - Fax:
Practice Address - Street 1:3242 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-9102
Practice Address - Country:US
Practice Address - Phone:270-618-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172672246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant