Provider Demographics
NPI:1669116018
Name:JONES, ROSA A (NP)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:JONES
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:ARYN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:423-283-9480
Practice Address - Street 1:2002 BROOKSIDE DR STE 300
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-530-7900
Practice Address - Fax:423-232-8580
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ076028Medicaid