Provider Demographics
NPI:1710652987
Name:JONES, NIKKI LYNN
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-1144
Mailing Address - Country:US
Mailing Address - Phone:209-754-1249
Mailing Address - Fax:
Practice Address - Street 1:3585 HAWVER RD
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9524
Practice Address - Country:US
Practice Address - Phone:209-754-1249
Practice Address - Fax:209-754-1087
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator