=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902905920
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TEDDY LYNN JONES R.N, F.N.P., PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 W 21ST ST
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88101-4086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-935-7777
-----------------------------------------------------
Fax | 505-935-7778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 734
-----------------------------------------------------
City | FRIONA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79035-0734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-638-1955
-----------------------------------------------------
Fax | 806-265-3525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 218392
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R36172
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------