MEDICARE: DAFFANY KAY 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	363LF0000X	Family Nurse Practitioner	593509	TX

General Provider Information

NPI Number	:	1255671921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAFFANY KAY JONES

Provider Business Mailing Address
First Line	:	21105 EVA ST
Second Line	:	SUITE 100
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-1706
Country	:	US
Telephone Number	:	936-597-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	21105 EVA ST
Second Line	:	SUITE 100
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-1706
Country	:	US
Telephone Number	:	936-597-8585
Fax Number	:

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

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	05/24/2013

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