Provider Demographics
NPI:1679123707
Name:JONES, KEITH L SR
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:JONES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 WASHINGTON AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1944
Mailing Address - Country:US
Mailing Address - Phone:314-354-6304
Mailing Address - Fax:314-354-6305
Practice Address - Street 1:1204 WASHINGTON AVE STE 408
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1944
Practice Address - Country:US
Practice Address - Phone:314-354-6304
Practice Address - Fax:314-354-6305
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017027668163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health