Provider Demographics
NPI:1902950249
Name:JONES, AMY LORETTA (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LORETTA
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6 WOODBROOK CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4448
Mailing Address - Country:US
Mailing Address - Phone:513-403-8560
Mailing Address - Fax:
Practice Address - Street 1:580 LINCOLN PARK BLVD STE 320
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3493
Practice Address - Country:US
Practice Address - Phone:937-299-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN249866163W00000X
OHRN.249866-COA1363LF0000X
OHAPRN.CNP.14431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2085729Medicaid