Provider Demographics
NPI:1154408169
Name:JONES, CLIFFORD (ARNP)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 E ORME ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2423
Mailing Address - Country:US
Mailing Address - Phone:316-686-7884
Mailing Address - Fax:316-686-0036
Practice Address - Street 1:8911 E ORME ST
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2423
Practice Address - Country:US
Practice Address - Phone:316-686-7884
Practice Address - Fax:316-686-0036
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-41899-092163WG0000X
KS74633363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100457120BMedicaid
161267Medicare ID - Type Unspecified