Provider Demographics
NPI:1588296685
Name:JONES, KATRINA ANN (LPN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:ANN
Other - Last Name:DUKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5990 VENTURE PARK DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1858
Mailing Address - Country:US
Mailing Address - Phone:269-532-1470
Mailing Address - Fax:269-532-1472
Practice Address - Street 1:2236 BROOK DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-2806
Practice Address - Country:US
Practice Address - Phone:269-492-7205
Practice Address - Fax:269-492-7204
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703097712164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse