Basic Information
Provider Information
NPI: 1003294752
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: CHRISTA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MHPP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1815 PLEASANT GROVE RD
Address2:  
City: JONESBORO
State: AR
PostalCode: 724017870
CountryCode: US
TelephoneNumber: 8709336886
FaxNumber: 8709339395
Practice Location
Address1: 1815 PLEASANT GROVE RD
Address2:  
City: JONESBORO
State: AR
PostalCode: 724017870
CountryCode: US
TelephoneNumber: 8709336886
FaxNumber: 8709339395
Other Information
ProviderEnumerationDate: 05/14/2015
LastUpdateDate: 05/22/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  N Other Service ProvidersCase Manager/Care Coordinator 
171M00000X ARY Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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