Provider Demographics
NPI:1093492902
Name:JONES, KENNETH RAY (NP)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:JONES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 MISTY PINES RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9013
Mailing Address - Country:US
Mailing Address - Phone:252-714-5072
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD # 1AD200
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-847-3898
Practice Address - Fax:252-847-6255
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018379363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty