Provider Demographics
NPI:1659069573
Name:JONES, EBONEE OTEELE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:EBONEE
Middle Name:OTEELE
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:EBONEE
Other - Middle Name:OTEELE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN, FNP-BC
Mailing Address - Street 1:1977 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5797
Mailing Address - Country:US
Mailing Address - Phone:757-771-8554
Mailing Address - Fax:
Practice Address - Street 1:1977 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5797
Practice Address - Country:US
Practice Address - Phone:757-771-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001264982163WS0200X
VA0024188916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool