Provider Demographics
NPI:1255044616
Name:JONES, DAGEN GUNNER
Entity type:Individual
Prefix:
First Name:DAGEN
Middle Name:GUNNER
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 BROOKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-7578
Mailing Address - Country:US
Mailing Address - Phone:417-280-6758
Mailing Address - Fax:
Practice Address - Street 1:2245 BROOKSIDE LN
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-7578
Practice Address - Country:US
Practice Address - Phone:417-280-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program