Provider Demographics
NPI:1457619819
Name:JONES, TERESA D (419097)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:JONES
Suffix:
Gender:F
Credentials:419097
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MISTY MOUNTAIN DR APT 21
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729-7743
Mailing Address - Country:US
Mailing Address - Phone:828-989-2183
Mailing Address - Fax:
Practice Address - Street 1:45 MISTY MOUNTAIN DR APT 21
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:NC
Practice Address - Zip Code:28729-7743
Practice Address - Country:US
Practice Address - Phone:828-989-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC372600000X
NC419097376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion