Provider Demographics
NPI:1528162567
Name:JONES, JACQUELYN DIANE (PSYNP)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:DIANE
Last Name:JONES
Suffix:
Gender:F
Credentials:PSYNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 S RURAL RD STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3717
Mailing Address - Country:US
Mailing Address - Phone:480-483-2726
Mailing Address - Fax:480-935-8662
Practice Address - Street 1:6625 S RURAL RD STE 111
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3717
Practice Address - Country:US
Practice Address - Phone:480-483-2726
Practice Address - Fax:480-935-8662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN109773363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ 72720Medicare PIN