Provider Demographics
NPI:1598967994
Name:JONES, DESIREE MICHELE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:MICHELE
Last Name:JONES
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501
Mailing Address - Country:US
Mailing Address - Phone:931-526-4433
Mailing Address - Fax:
Practice Address - Street 1:1362 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-4108
Practice Address - Country:US
Practice Address - Phone:865-354-1220
Practice Address - Fax:865-354-0112
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87825163W00000X
TN6538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902690Medicaid
TN3902690Medicaid
TN3373453Medicare ID - Type Unspecified
TNMJO483684OtherDEA