Provider Demographics
NPI:1184777120
Name:JONES, STEPHANIE (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 W CHARLESTON BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1963
Mailing Address - Country:US
Mailing Address - Phone:702-780-2312
Mailing Address - Fax:702-895-4014
Practice Address - Street 1:3121 S MARYLAND PKWY STE 400
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2309
Practice Address - Country:US
Practice Address - Phone:702-250-2500
Practice Address - Fax:702-250-2220
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO21702086S0120X
CAA118132086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184777120Medicaid