Provider Demographics
NPI:1124505649
Name:JONES, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1744
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-8544
Mailing Address - Country:US
Mailing Address - Phone:662-351-2035
Mailing Address - Fax:
Practice Address - Street 1:220 SUNFLOWER AVE
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4221
Practice Address - Country:US
Practice Address - Phone:662-351-2035
Practice Address - Fax:662-351-2045
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08987242Medicaid