MEDICARE: MR. JOHNNY MICHAEL JONES MSN, APRN, FNP-C

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	163W00000X	Registered Nurse	788612	TX
2	363LF0000X	Family Nurse Practitioner	AP135226	TX

General Provider Information

NPI Number	:	1760994875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHNNY MICHAEL JONES MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	3210 56TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79413-4811
Country	:	US
Telephone Number	:	806-474-4392
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 56TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79413-4811
Country	:	US
Telephone Number	:	806-474-4392
Fax Number	:

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

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	10/30/2017

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