Provider Demographics
NPI:1841236254
Name:JONES, JEFFREY (NP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 N STATE ROUTE 91
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9541
Mailing Address - Country:US
Mailing Address - Phone:309-692-5393
Mailing Address - Fax:309-692-2538
Practice Address - Street 1:8600 N STATE ROUTE 91
Practice Address - Street 2:SUITE 250
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9541
Practice Address - Country:US
Practice Address - Phone:309-692-5393
Practice Address - Fax:309-692-2538
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363L00000X, 363LA2100X, 363LA2200X, 363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00279010OtherMEDICARE RAILROAD NUMBER
ILP00279010OtherMEDICARE RAILROAD NUMBER
ILK23003Medicare ID - Type UnspecifiedMEDICAR PROVIDER NUMBER