Provider Demographics
NPI:1700201555
Name:JONES, LASHELL
Entity Type:Individual
Prefix:
First Name:LASHELL
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5470 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120-2412
Mailing Address - Country:US
Mailing Address - Phone:314-755-1166
Mailing Address - Fax:314-755-1177
Practice Address - Street 1:8401 LATTY AVE
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3214
Practice Address - Country:US
Practice Address - Phone:314-616-1268
Practice Address - Fax:314-942-1337
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374U00000X
MO376K0000X376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
21781656OtherTIN
MO38-3896672OtherFEDERAL IDENTIFICATION NUMBER
MO$$$$$$$$$OtherSOCIAL SECURITY NUMBER