Provider Demographics
NPI:1669079398
Name:JONES, TA-KISHA (MBA, CHES, CHWC)
Entity type:Individual
Prefix:
First Name:TA-KISHA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MBA, CHES, CHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 SOUTH STATE RD 135
Mailing Address - Street 2:SUITE D#192
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 SOUTH STATE RD 135
Practice Address - Street 2:SUITE D#192
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143
Practice Address - Country:US
Practice Address - Phone:317-279-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty