Provider Demographics
NPI:1285671362
Name:JONES, MARY KATHRYN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY KATHRYN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 VIEWMONT DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1699
Mailing Address - Country:US
Mailing Address - Phone:570-207-4360
Mailing Address - Fax:570-383-1940
Practice Address - Street 1:407 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1097
Practice Address - Country:US
Practice Address - Phone:570-586-1134
Practice Address - Fax:570-586-1136
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP003760B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027889120003Medicaid
PA1027889120005Medicaid
PA1027889120002Medicaid