Provider Demographics
NPI:1356923759
Name:JONES, NIKI SIMONE
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:SIMONE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 THOUSAND OAKS DR STE 28
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3206
Mailing Address - Country:US
Mailing Address - Phone:210-789-4139
Mailing Address - Fax:
Practice Address - Street 1:2947 THOUSAND OAKS DR STE 28
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3206
Practice Address - Country:US
Practice Address - Phone:210-789-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13370721744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management