Provider Demographics
NPI:1811874787
Name:JONES, TEARLE
Entity type:Individual
Prefix:
First Name:TEARLE
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 BONANZA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8127
Mailing Address - Country:US
Mailing Address - Phone:928-322-9036
Mailing Address - Fax:505-772-9077
Practice Address - Street 1:96 BONANZA CREEK RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8127
Practice Address - Country:US
Practice Address - Phone:928-322-9036
Practice Address - Fax:928-322-9036
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications