Provider Demographics
NPI:1063193753
Name:JONES, KORTESHA J (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:KORTESHA
Middle Name:J
Last Name:JONES
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W JEFFERY ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-4957
Mailing Address - Country:US
Mailing Address - Phone:815-549-3894
Mailing Address - Fax:
Practice Address - Street 1:244 W JEFFERY ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-4957
Practice Address - Country:US
Practice Address - Phone:815-549-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01870041-22202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology