Provider Demographics
NPI:1700386414
Name:JONES, BRYAN KEITH (LVN)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:KEITH
Last Name:JONES
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 COUNTY ROAD 490
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-3305
Mailing Address - Country:US
Mailing Address - Phone:903-694-9856
Mailing Address - Fax:
Practice Address - Street 1:550 COUNTY ROAD 490
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-3305
Practice Address - Country:US
Practice Address - Phone:903-694-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207717164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse