Provider Demographics
NPI:1447717053
Name:JONES, CRYSTAL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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 2724
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-2724
Mailing Address - Country:US
Mailing Address - Phone:504-782-6558
Mailing Address - Fax:
Practice Address - Street 1:385 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-6503
Practice Address - Country:US
Practice Address - Phone:504-782-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily