Healthcare Provider Details

I. General information

NPI: 1982305793
Provider Name (Legal Business Name): CRYSTAL JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 UNION AVE SUITE 544
MEMPHIS TN
38104
US

IV. Provider business mailing address

1100 OAK STREET SUITE 18
CONWAY AR
72032
US

V. Phone/Fax

Practice location:
  • Phone: 501-237-1878
  • Fax: 501-521-1533
Mailing address:
  • Phone: 501-773-7755
  • Fax: 501-521-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: