Provider Demographics
NPI:1750657839
Name:JONES, LAURA BETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1021 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-3274
Mailing Address - Country:US
Mailing Address - Phone:731-646-1781
Mailing Address - Fax:731-646-1786
Practice Address - Street 1:1021 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-3274
Practice Address - Country:US
Practice Address - Phone:731-646-1781
Practice Address - Fax:731-646-1786
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1035I07685OtherMEDICARE