MEDICARE: MRS. NERECA CAROL JONES HOUSE WIFE

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1811546278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NERECA CAROL JONES HOUSE WIFE

Provider Business Mailing Address
First Line	:	5011 COLONIAL AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215
Country	:	US
Telephone Number	:	214-245-2423
Fax Number	:

Provider Business Practice Location Address
First Line	:	5011 COLONIAL AVENUE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215
Country	:	US
Telephone Number	:	214-565-8377
Fax Number	:

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

Provider Enumeration Date	:	09/09/2019
Last Update Date	:	09/09/2019

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