Provider Demographics
NPI:1336197672
Name:JONES, LISA SUE (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SUE
Last Name:JONES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PLAZA DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2916
Mailing Address - Country:US
Mailing Address - Phone:812-376-5974
Mailing Address - Fax:812-375-3203
Practice Address - Street 1:2400 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5351
Practice Address - Country:US
Practice Address - Phone:812-376-5974
Practice Address - Fax:812-375-3203
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001246363L00000X
IN71001246A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200531190Medicaid
INP01292242OtherRAILROAD MEDICARE FOR CRITICAL CARE GROUP
IN715320023Medicare PIN
INP01292242OtherRAILROAD MEDICARE FOR CRITICAL CARE GROUP
INQ53698Medicare UPIN
IN267030012Medicare PIN
IN264430OMedicare PIN
IN264910IAAMedicare PIN