Provider Demographics
NPI:1083914261
Name:JONES, KORTNI R (PA-C)
Entity Type:Individual
Prefix:
First Name:KORTNI
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KORTNI
Other - Middle Name:R
Other - Last Name:COKELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1108 W INDIAN SCHOOL RD STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3115
Mailing Address - Country:US
Mailing Address - Phone:602-773-5600
Mailing Address - Fax:602-773-5601
Practice Address - Street 1:301 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1214
Practice Address - Country:US
Practice Address - Phone:602-773-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005908363A00000X
AZ7414207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601005908OtherSTATE OF MI LIC