Provider Demographics
NPI:1710561832
Name:JONES, MIA LYNN
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:LYNN
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 1:10 MOUNTAIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8992
Mailing Address - Country:US
Mailing Address - Phone:304-816-3687
Mailing Address - Fax:304-816-3737
Practice Address - Street 1:10 MOUNTAIN PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8992
Practice Address - Country:US
Practice Address - Phone:304-816-3687
Practice Address - Fax:304-816-3737
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant