Provider Demographics
NPI:1821291683
Name:JONES, NICHOLE M (NP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10365 COOPER RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-7619
Mailing Address - Country:US
Mailing Address - Phone:901-842-1473
Mailing Address - Fax:901-844-1439
Practice Address - Street 1:10365 COOPER RIDGE CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-7619
Practice Address - Country:US
Practice Address - Phone:901-842-1473
Practice Address - Fax:901-844-1439
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12615363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3342252Medicare PIN