=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528140969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND PAUL JONES RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 POPE AVE
-----------------------------------------------------
City | FORT LEAVENWORTH
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66027-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-684-6442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7404 NW 85TH TER
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64153-3700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-505-3573
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | 112035
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------