Individual
CRYSTAL TRENIKA JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1212 SALLY MAE ST, LAKE CHARLES, LA 70601-1530
(337) 707-5635
Mailing address
PO BOX 1222, WESTLAKE, LA 70669-1222
(337) 707-5635
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
008221900
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83-2358572
NEMT
—
05
—
83-2358572
—
LA
Enumeration date
11/06/2018
Last updated
11/06/2018
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