MEDICARE: KAYLYN NICOLE JONES LCSW

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	1041C0700X	Clinical Social Worker	C015631	NC

General Provider Information

NPI Number	:	1447806054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLYN NICOLE JONES LCSW

Provider Business Mailing Address
First Line	:	3811 VINING CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-3116
Country	:	US
Telephone Number	:	336-457-4324
Fax Number	:

Provider Business Practice Location Address
First Line	:	4412 PARK RD STE B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3130
Country	:	US
Telephone Number	:	980-217-6901
Fax Number	:

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

Provider Enumeration Date	:	08/11/2019
Last Update Date	:	05/23/2023

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