Healthcare Provider Details

I. General information

NPI: 1770836595
Provider Name (Legal Business Name): TAMARA E JONES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 BROOKEHAVEN RD
NEW ALBANY IN
47150
US

IV. Provider business mailing address

3021 BROOKEHAVEN RD
NEW ALBANY IN
47150
US

V. Phone/Fax

Practice location:
  • Phone: 812-989-8187
  • Fax:
Mailing address:
  • Phone: 812-989-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number28091786A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1131260
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number710060225A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number1131260
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: