Healthcare Provider Details

I. General information

NPI: 1679703623
Provider Name (Legal Business Name): KRYSTAL S COLVIN JONES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 STATE ROUTE 76
WILLOW SPRINGS MO
65793-8254
US

IV. Provider business mailing address

2642 ST. RT. 76
WILLOW SPRINGS MO
65793-0309
US

V. Phone/Fax

Practice location:
  • Phone: 417-469-5124
  • Fax: 417-469-1165
Mailing address:
  • Phone: 417-469-5124
  • Fax: 417-469-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2001018537
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: