Provider Demographics
NPI:1912407495
Name:JONES, WANDA JOYCE
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:JOYCE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:JOYCE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3507 FORESTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-2346
Mailing Address - Country:US
Mailing Address - Phone:903-336-9567
Mailing Address - Fax:
Practice Address - Street 1:3507 FORESTWOOD ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2346
Practice Address - Country:US
Practice Address - Phone:903-336-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL038953164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse