Provider Demographics
NPI:1609465517
Name:JONES, JESSIE WARREN
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:WARREN
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:REBECCA
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:508 AUSLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAMSON
Mailing Address - State:AL
Mailing Address - Zip Code:36477-5742
Mailing Address - Country:US
Mailing Address - Phone:334-717-0884
Mailing Address - Fax:
Practice Address - Street 1:508 AUSLEY RD
Practice Address - Street 2:
Practice Address - City:SAMSON
Practice Address - State:AL
Practice Address - Zip Code:36477-5742
Practice Address - Country:US
Practice Address - Phone:334-717-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL23088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program