Provider Demographics
NPI:1659480663
Name:JONES, STEPHANIE JEAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JEAN
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3108 TAM O SHANTER DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1832
Mailing Address - Country:US
Mailing Address - Phone:785-640-5627
Mailing Address - Fax:785-625-7667
Practice Address - Street 1:3108 TAM O SHANTER DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1832
Practice Address - Country:US
Practice Address - Phone:785-640-5627
Practice Address - Fax:785-625-7667
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1380775032367500000X
KS55418367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000145134OtherBLUE CROSS OF KS
KSP00209315Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KS145134Medicare ID - Type Unspecified