Provider Demographics
NPI:1720600810
Name:JONES, TEDRIL NICOLE
Entity Type:Individual
Prefix:MS
First Name:TEDRIL
Middle Name:NICOLE
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 1:62200 WESTEND BLVD APT 7103
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5638
Mailing Address - Country:US
Mailing Address - Phone:504-300-6591
Mailing Address - Fax:
Practice Address - Street 1:62200 WESTEND BLVD APT 7103
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5638
Practice Address - Country:US
Practice Address - Phone:504-300-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006943351347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle