MEDICARE: ELLEN MICHELLE 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	390200000X	Student in an Organized Health Care Education/Training Program		VA
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1457204620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN MICHELLE JONES

Provider Business Mailing Address
First Line	:	306 GREGORY DR
Second Line	:
City	:	SEAFORD
State	:	VA
Zip	:	23696-2489
Country	:	US
Telephone Number	:	757-660-2339
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 MOSS CREEK DR APT D
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-1826
Country	:	US
Telephone Number	:	757-660-2339
Fax Number	:

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

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	05/18/2026

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