Provider Demographics
NPI:1770808396
Name:JONES, KRISTY LYNN (DO)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 W WALNUT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-877-7820
Mailing Address - Fax:479-877-7821
Practice Address - Street 1:2110 W WALNUT
Practice Address - Street 2:SUITE 100
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-877-7820
Practice Address - Fax:479-877-7821
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9566208000000X, 207R00000X
MO2014014083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1770808396Medicaid
MOX43000020Medicare Oscar/Certification