Provider Demographics
NPI:1730658816
Name:JONES, VIVIAN PALACIOS (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:PALACIOS
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:VIVIN
Other - Middle Name:CHRISTINE
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12315 STABLE PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4623
Mailing Address - Country:US
Mailing Address - Phone:210-381-6687
Mailing Address - Fax:
Practice Address - Street 1:101 S EUGENIA ST
Practice Address - Street 2:
Practice Address - City:ORANGE GROVE
Practice Address - State:TX
Practice Address - Zip Code:78372
Practice Address - Country:US
Practice Address - Phone:361-382-2024
Practice Address - Fax:855-606-6314
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-18
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0003689-C-NP363LP0808X
TXAP139581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health