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NPI Code Detail

MEDICARE: RYAN GRANT JONES PSY.D.

MEDICARE:   RYAN GRANT JONES  PSY.D.
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
1103TC0700XClinical Psychologist2013020719MO
2103G00000XClinical Neuropsychologist2013020719MO

General Provider Information

NPI Number : 1023459971
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN GRANT JONES PSY.D.
Provider Business Mailing Address
First Line : 1864 S KENTWOOD AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-2323
Country : US
Telephone Number : 417-880-6838
Fax Number : 417-374-0074
Provider Business Practice Location Address
First Line : 1864 S KENTWOOD AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-2323
Country : US
Telephone Number : 417-880-6838
Fax Number : 417-374-0074
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2013
Last Update Date : 05/24/2021

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