MEDICARE: PHYLLIS JONES CRNP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R093435	MD
2	363LF0000X	Family Nurse Practitioner	290247	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	6033167001	OTHER	CIGNA
2	60851801	OTHER	CAREFIRST
3	0011	OTHER	CAREFIRST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396710745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS JONES CRNP

Provider Business Mailing Address
First Line	:	1001 ROCK QUARRY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-3825
Country	:	US
Telephone Number	:	919-833-3111
Fax Number	:	919-340-0271

Provider Business Practice Location Address
First Line	:	111 S CHURCH ST
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2501
Country	:	US
Telephone Number	:	919-833-3111
Fax Number	:	919-340-0271

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	11/09/2016

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