Healthcare Provider Details

I. General information

NPI: 1053482661
Provider Name (Legal Business Name): CARMEN ANN JONES CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PRINCE WILLIAM RD
DELPHI IN
46923-1758
US

IV. Provider business mailing address

502 N UNIVERSITY ST
WEST LAFAYETTE IN
47907-2069
US

V. Phone/Fax

Practice location:
  • Phone: 765-564-3016
  • Fax:
Mailing address:
  • Phone: 765-494-0311
  • Fax: 765-494-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001221A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200351840
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: