Provider Demographics
NPI:1760163042
Name:JONES, STACY LEAH
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LEAH
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 1:645 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2922
Mailing Address - Country:US
Mailing Address - Phone:504-493-5516
Mailing Address - Fax:
Practice Address - Street 1:645 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-2922
Practice Address - Country:US
Practice Address - Phone:504-493-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA100267903156F00000X
LA156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist