Provider Demographics
NPI:1912365149
Name:NONE
Entity Type:Organization
Organization Name:NONE
Other - Org Name:LINDA MARIE JONES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:512-630-8511
Mailing Address - Street 1:1324 VINTON AVE # 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4558
Mailing Address - Country:US
Mailing Address - Phone:512-630-8511
Mailing Address - Fax:
Practice Address - Street 1:1324 VINTON AVE # 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4558
Practice Address - Country:US
Practice Address - Phone:512-630-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care