Provider Demographics
NPI:1952392474
Name:MARION, JONNA WINN (FNP)
Entity Type:Individual
Prefix:
First Name:JONNA
Middle Name:WINN
Last Name:MARION
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JONNA
Other - Middle Name:WINN
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1202 BELAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79323-9547
Mailing Address - Country:US
Mailing Address - Phone:806-215-5564
Mailing Address - Fax:
Practice Address - Street 1:2000 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6119
Practice Address - Country:US
Practice Address - Phone:806-592-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114369363L00000X
TX646748363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137227806Medicaid
TX137227810Medicaid
TX0082EVOtherBLUE CROSS/BLUE SHIELD
TXHH0448OtherBCBS
TX0082EVOtherBLUE CROSS/BLUE SHIELD
458811Medicare Oscar/Certification