Healthcare Provider Details

I. General information

NPI: 1689631756
Provider Name (Legal Business Name): KATHLEEN M JONES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W LOSEY ST 375 AMDS/SGPF
SCOTT AIR FORCE BASE IL
62225-5250
US

IV. Provider business mailing address

310 W LOSEY ST 375 AMDS/SGPF
SCOTT AIR FORCE BASE IL
62225-5250
US

V. Phone/Fax

Practice location:
  • Phone: 618-256-9355
  • Fax:
Mailing address:
  • Phone: 618-256-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number20364
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20364
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: