Provider Demographics
NPI:1790868305
Name:JONES, JENNIFER N (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-0309
Mailing Address - Country:US
Mailing Address - Phone:843-554-9300
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-751-2740
Practice Address - Fax:765-741-2905
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055271A207ZC0500X
IN0105571A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6470OtherPHYSICIAN HEALTH PLAN
OH2099554Medicaid
IN000000032203OtherM-PLAN
IN000000374079OtherBLUE CROSS BLUE SHIELD
IN000000374079OtherBLUE CROSS BLUE SHIELD
IN6470OtherPHYSICIAN HEALTH PLAN
IN203790WMedicare PIN