Healthcare Provider Details

I. General information

NPI: 1003739236
Provider Name (Legal Business Name): KAITLYN OBRIEN JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 OTTERBURN RD
AMELIA COURT HOUSE VA
23002-4884
US

IV. Provider business mailing address

412 W HIGH ST
SOUTH HILL VA
23970-1622
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-2621
  • Fax:
Mailing address:
  • Phone: 804-201-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012506
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: