=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013535137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN A JONES NURSE PRACTITIONER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2020
-----------------------------------------------------
Last Update Date | 12/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5323 HARRY HINES BLVD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75390-1402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-648-3111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1008 N RICHMOND AVE
-----------------------------------------------------
City | LINDENHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11757-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-741-6108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 431762
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------