Healthcare Provider Details

I. General information

NPI: 1669057345
Provider Name (Legal Business Name): JONAH ALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HOSPITAL DR STE 5A
HENDERSONVILLE NC
28792-5247
US

IV. Provider business mailing address

PO BOX 1869
FLETCHER NC
28732-1869
US

V. Phone/Fax

Practice location:
  • Phone: 828-684-1115
  • Fax: 828-687-6064
Mailing address:
  • Phone:
  • Fax: 828-650-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5014197.
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: