Healthcare Provider Details

I. General information

NPI: 1053963124
Provider Name (Legal Business Name): KAITLYN JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

439 GOLDEN MEADOWS CIR
SUWANEE GA
30024-2269
US

V. Phone/Fax

Practice location:
  • Phone: 678-267-9162
  • Fax:
Mailing address:
  • Phone: 678-267-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-5774
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: