Healthcare Provider Details

I. General information

NPI: 1407796683
Provider Name (Legal Business Name): COURTNEY JEAN JONES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6023
US

IV. Provider business mailing address

1241 W STADIUM BLVD
JEFFERSON CITY MO
65109-6023
US

V. Phone/Fax

Practice location:
  • Phone: 573-635-5264
  • Fax:
Mailing address:
  • Phone: 573-635-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026013849
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: