MEDICARE: GAIL JONES PROVOST

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor
2	246RM2200X	Medical Laboratory Technician	LA
3	247ZC0005X	Clinical Laboratory Director (Non-physician)	LA

General Provider Information

NPI Number	:	1174166748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL JONES PROVOST

Provider Business Mailing Address
First Line	:	7730 WINDWARD CT
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-1339
Country	:	US
Telephone Number	:	504-237-2189
Fax Number	:	504-241-1649

Provider Business Practice Location Address
First Line	:	9954 LAKE FOREST BLVD STE 5
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-5498
Country	:	US
Telephone Number	:	504-237-2189
Fax Number	:	504-241-1649

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

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	10/04/2024

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Directions to “ GAIL JONES PROVOST ” Practice Location

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