Provider Demographics
NPI:1609588094
Name:JONES, VICKIE DENISE (AGPCNP- BC)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:DENISE
Last Name:JONES
Suffix:
Gender:F
Credentials:AGPCNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 ASH GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-7429
Mailing Address - Country:US
Mailing Address - Phone:817-988-3745
Mailing Address - Fax:
Practice Address - Street 1:2336 ASH GROVE TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-7429
Practice Address - Country:US
Practice Address - Phone:817-988-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1102195363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care