Healthcare Provider Details

I. General information

NPI: 1275593402
Provider Name (Legal Business Name): KATHRYN MITCHELL JONES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680B RIBAUT ROAD
PORT ROYAL SC
29935-2008
US

IV. Provider business mailing address

1680B RIBAUT ROAD
PORT ROYAL SC
29935-2008
US

V. Phone/Fax

Practice location:
  • Phone: 843-521-9879
  • Fax: 843-521-9879
Mailing address:
  • Phone: 843-521-9879
  • Fax: 843-521-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1891
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: