Healthcare Provider Details

I. General information

NPI: 1386352698
Provider Name (Legal Business Name): RAVEN SHARIE JONES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MATTHEWS TOWNSHIP PKWY STE 300
MATTHEWS NC
28105-5332
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-6860
  • Fax:
Mailing address:
  • Phone: 704-316-6860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5017193
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: