Provider Demographics
NPI:1093808578
Name:JONES, MICHELLE Y (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:Y
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PASADENA DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2978
Mailing Address - Country:US
Mailing Address - Phone:859-977-4005
Mailing Address - Fax:859-977-4006
Practice Address - Street 1:185 PASADENA DR STE 230
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2978
Practice Address - Country:US
Practice Address - Phone:859-977-4005
Practice Address - Fax:859-977-4006
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA092363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GROUP#
KY95000006Medicaid
KY970021363OtherRR MEDICARE PIN#
KY4000501OtherMEDICARE LAB GROUP#
KYCB5773OtherRR MEDICARE GROUP#
KYCB5773OtherRR MEDICARE GROUP#
KY4000501OtherMEDICARE LAB GROUP#