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General NPI Number Information
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NPI Number | 1245225820
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Entity Type | Individual
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Provider Name | LISA D JONES RD, LD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 24 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-1476
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Country | US
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Telephone | 304-720-2222
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Fax | 304-720-2322
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Provider Business Mailing Address
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Address Line | 24 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25303-1476
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Country | US
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Telephone | 304-720-2222
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Fax | 304-720-2322
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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 | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | 464
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License Number State | WV
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