Provider Demographics
NPI:1962922252
Name:JONES, JESSICA LOUISE (DO)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LOUISE
Last Name:JONES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:401 W MCGALLIARD RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1828
Mailing Address - Country:US
Mailing Address - Phone:765-288-6200
Mailing Address - Fax:765-288-4131
Practice Address - Street 1:401 W MCGALLIARD RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1828
Practice Address - Country:US
Practice Address - Phone:765-288-6200
Practice Address - Fax:765-288-4131
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006868A207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300066576Medicaid