MEDICARE: KEEMASHEKA JONES LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN5182304	FL

General Provider Information

NPI Number	:	1033631023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEEMASHEKA JONES LPN

Provider Business Mailing Address
First Line	:	2307 MONDAY RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-6115
Country	:	US
Telephone Number	:	850-815-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 MONDAY RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-6115
Country	:	US
Telephone Number	:	850-815-0660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	07/21/2022

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