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General NPI Number Information
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NPI Number | 1093492902
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Entity Type | Individual
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Provider Name | KENNETH RAY JONES NP
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Gender | Male
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 07/09/2023
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Provider Practice Location Address
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Address Line | 2100 STANTONSBURG RD # 1AD200
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City | GREENVILLE
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State | NC
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Zip | 27834-2818
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Country | US
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Telephone | 252-847-3898
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Fax | 252-847-6255
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Provider Business Mailing Address
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Address Line | 3328 MISTY PINES RD
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City | GREENVILLE
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State | NC
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Zip | 27858-9013
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Country | US
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Telephone | 252-714-5072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 5018379
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License Number State | NC
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