Provider Demographics
NPI:1306859996
Name:JONES, BRENDA B (CNM)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:B
Last Name:JONES
Suffix:
Gender:F
Credentials:CNM
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 4745
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-0745
Mailing Address - Country:US
Mailing Address - Phone:423-702-7667
Mailing Address - Fax:423-702-7668
Practice Address - Street 1:251 N LYERLY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-648-7770
Practice Address - Fax:423-648-7772
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1075132367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS52659Medicare UPIN
FLY6412XMedicare ID - Type Unspecified