Provider Demographics
NPI:1760946495
Name:JONES, LORI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:KEINATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6940 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48722-9760
Mailing Address - Country:US
Mailing Address - Phone:989-746-0933
Mailing Address - Fax:
Practice Address - Street 1:6940 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9760
Practice Address - Country:US
Practice Address - Phone:989-746-0933
Practice Address - Fax:989-746-5070
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily