Provider Demographics
NPI:1942607148
Name:JONES, ANDREA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 301 ANDREWS AVE
Mailing Address - Street 2:LYSTER ARMY HEALTH CLINIC
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7363
Mailing Address - Fax:
Practice Address - Street 1:303 INGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-4153
Practice Address - Country:US
Practice Address - Phone:334-255-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1678133V00000X
FLND11503133V00000X
GALD006255133V00000X
MDDX5726133V00000X
IL164.009998133V00000X
952913133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered