Provider Demographics
NPI:1831650506
Name:JONES, KANISHIA CHARISSE
Entity Type:Individual
Prefix:
First Name:KANISHIA
Middle Name:CHARISSE
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 1:4225 BACON ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2043
Mailing Address - Country:US
Mailing Address - Phone:901-230-8154
Mailing Address - Fax:
Practice Address - Street 1:4225 BACON ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2043
Practice Address - Country:US
Practice Address - Phone:901-230-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle