Provider Demographics
NPI:1275081986
Name:JONES, MICHELLE B (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:B
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KNIGHTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-569-7983
Mailing Address - Fax:502-589-4989
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:HOSPITALIST DEPARTMENT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1886
Practice Address - Country:US
Practice Address - Phone:502-569-7983
Practice Address - Fax:502-589-4989
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC505363A00000X
KYPA2149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300015600Medicaid
KY7100439930Medicaid