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General NPI Number Information
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NPI Number | 1417057779
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Entity Type | Individual
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Provider Name | KELLY N JONES MD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 15945 CLAYTON RD STE 310
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City | BALLWIN
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State | MO
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Zip | 63011-2493
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Country | US
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Telephone | 636-893-1356
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Fax | 636-893-1358
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 636-893-1356
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Fax | 636-893-1358
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-116148
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 036116148
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024038766
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License Number State | MO
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