=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114738713
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAVEN ALEXIS JONES APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2025
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 156 ISLAND CREEK RD
-----------------------------------------------------
City | PIKEVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41501-9340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-432-3221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 JONES TOWN CIR
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-8052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-585-7956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 4020262
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------