Provider Demographics
NPI:1932741816
Name:JONES, CONNY (LPN)
Entity Type:Individual
Prefix:
First Name:CONNY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 29 EAST BOULDER STREET
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3169
Mailing Address - Country:US
Mailing Address - Phone:704-352-2830
Mailing Address - Fax:
Practice Address - Street 1:4519 FENCER RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3619
Practice Address - Country:US
Practice Address - Phone:719-257-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-12
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04J425374U00000X
COPN.0335330164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide