Provider Demographics
NPI:1699282988
Name:JONES, VICTORIA MICHELLE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MICHELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:ARNP
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 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:9390 BUNSEN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3789
Practice Address - Country:US
Practice Address - Phone:833-358-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011837363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001354703OtherANTHEM PROVIDER ID NUMBER
6697404OtherUNITED HEALTHCARE PROVIDER ID NUMBER
KY7100513560Medicaid
IN300035863Medicaid
CS2010400216OtherCARESOURCE PROVIDER ID NUMBER
KYPDZ000000439578OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER