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General NPI Number Information
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NPI Number | 1154535417
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Entity Type | Individual
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Provider Name | KENNETH B. JONES PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 310 MID-CONTINENT PLAZA SUITE 606
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City | WEST MEMPHIS
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State | AR
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Zip | 72301
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Country | US
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Telephone | 901-292-8074
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Fax | 901-507-7929
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Provider Business Mailing Address
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Address Line | 754 TEALWOOD LN.
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City | CORDOVA
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State | TN
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Zip | 38018-6333
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Country | US
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Telephone | 901-292-8074
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Fax | 901-507-7929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 06-17P
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License Number State | AR
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