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General NPI Number Information
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NPI Number | 1821487844
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Entity Type | Individual
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Provider Name | AUDRA K JONES FNP
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Gender | Female
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 12425 CROSSROADS RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-4443
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Country | US
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Telephone | 662-468-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 12425 CROSSROADS RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-4443
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Country | US
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Telephone | 662-468-1300
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Fax | 662-470-1952
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R890664
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License Number State | MS
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