Provider Demographics
NPI:1710195037
Name:JONES, BERNICE CLAIR (CARE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:CLAIR
Last Name:JONES
Suffix:
Gender:F
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W FIREWEED LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2003
Mailing Address - Country:US
Mailing Address - Phone:907-263-1915
Mailing Address - Fax:907-248-0639
Practice Address - Street 1:121 W FIREWEED LN
Practice Address - Street 2:SUITE 105
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2003
Practice Address - Country:US
Practice Address - Phone:907-263-1915
Practice Address - Fax:907-248-0639
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM1006Medicaid