MEDICARE: MIRANDA LEIGH JONES PA-C

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-07076	NC
2	363A00000X	Physician Assistant	MPA.5693	SC
3	207RC0000X	Cardiovascular Disease Physician	0010-07076	NC
4	363A00000X	Physician Assistant	PA.0007445	CO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1205373081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA LEIGH JONES PA-C

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	336-481-8655
Fax Number	:	336-277-9165

Provider Business Practice Location Address
First Line	:	125 QUEENS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3278
Country	:	US
Telephone Number	:	704-343-9800
Fax Number	:	704-347-2011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	11/19/2025

125 QUEENS RD STE 610&640
CHARLOTTE, NC
28204-3278

Practice Phone: 980-302-6600
Practice Fax: 980-302-6605