Basic Information
| Provider Information | |||||||||
| NPI: | 1881910669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | GLEN | ||||||||
| MiddleName: | DARNELL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 LINDAUER CV | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723352932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013108899 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1030 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381042127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015238990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 04/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R82671 | AR | Y | Nursing Service Providers | Registered Nurse | 163WC0200X | R82671 | AR | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 163WE0003X | R82671 | AR | N | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.