Provider Demographics
NPI:1447525522
Name:JONES, MYRNA JO (LMP)
Entity type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:JO
Last Name:JONES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 GEORGE WASHINGTON WAY STE B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2382
Mailing Address - Country:US
Mailing Address - Phone:509-947-4493
Mailing Address - Fax:
Practice Address - Street 1:1901 GEORGE WASHINGTON WAY STE B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2382
Practice Address - Country:US
Practice Address - Phone:509-947-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602067424225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist