Individual
JACK JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 E FERGUSON ST, TYLER, TX 75702-5759
(903) 705-0070
Mailing address
305 PINE ST, CENTER, TX 75935-4057
(936) 591-0461
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
614402
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
614402
TX BON
TX
Enumeration date
08/31/2018
Last updated
08/31/2018
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