MEDICARE: DEBRA SPICELY JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1003476219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA SPICELY JONES

Provider Business Mailing Address
First Line	:	1 HAYDEN DR PO BOX 9081
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23806-0001
Country	:	US
Telephone Number	:	804-524-5847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HAYDEN DR
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-2520
Country	:	US
Telephone Number	:	804-524-5847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	06/19/2019

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Directions to “ DEBRA SPICELY JONES ” Practice Location

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