Provider Demographics
NPI:1275593402
Name:JONES, KATHRYN MITCHELL (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MITCHELL
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680B RIBAUT ROAD
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2008
Mailing Address - Country:US
Mailing Address - Phone:843-521-9879
Mailing Address - Fax:843-521-9879
Practice Address - Street 1:1680B RIBAUT ROAD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2008
Practice Address - Country:US
Practice Address - Phone:843-521-9879
Practice Address - Fax:843-521-9879
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1209600001OtherDMERC
SCNP0697Medicaid
SCP981495623Medicare PIN
SC1209600001OtherDMERC