Provider Demographics
NPI:1528507308
Name:JONES, KRISTIN D (MA, ATC, LAT)
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:D
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY PLZ
Mailing Address - Street 2:MS 7000
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4710
Mailing Address - Country:US
Mailing Address - Phone:573-651-2858
Mailing Address - Fax:573-986-6156
Practice Address - Street 1:1 UNIVERSITY PLZ
Practice Address - Street 2:MS 7000
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4710
Practice Address - Country:US
Practice Address - Phone:573-651-2858
Practice Address - Fax:573-986-6156
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140226052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer