Provider Demographics
NPI:1811397631
Name:JONES, KELLY JEAN (CSFA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:JONES
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 N LOCUST ST APT 1123
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-7495
Mailing Address - Country:US
Mailing Address - Phone:812-345-7764
Mailing Address - Fax:
Practice Address - Street 1:3232 N LOCUST ST APT 1123
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-7495
Practice Address - Country:US
Practice Address - Phone:812-345-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist