Healthcare Provider Details

I. General information

NPI: 1336518265
Provider Name (Legal Business Name): EUDORA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3587 BUCKLEY DR
JEFFERSON MD
21755-8255
US

IV. Provider business mailing address

66 E MAIN STREET 2ND AND 3RD FLOOR (PRIVATE OFFICE 303)
WESTMINSTER MD
21157
US

V. Phone/Fax

Practice location:
  • Phone: 301-339-4091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR173104
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR173104
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: