Individual
MR. DWIGHT MOODY JONES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-BC
Contact information
Practice address
109 EAST ST, CLARENCE, MO 63437-1902
(660) 699-2124
(660) 699-3534
Mailing address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 367-7010
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
2012006982
MO
363LF0000X
Family Nurse Practitioner
Primary
2013028349
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013028349
STATE LICENSE
MO
Enumeration date
03/02/2012
Last updated
03/17/2022
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