Provider Demographics
NPI:1710230008
Name:JONES, MELISSA ROSE (RN, BSN, SANE)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ROSE
Last Name:JONES
Suffix:
Gender:F
Credentials:RN, BSN, SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19175 COUNTY ROAD 7300
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65550-9073
Mailing Address - Country:US
Mailing Address - Phone:573-596-1680
Mailing Address - Fax:573-596-0423
Practice Address - Street 1:126 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8952
Practice Address - Country:US
Practice Address - Phone:573-596-1680
Practice Address - Fax:573-596-0423
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108884163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse