Provider Demographics
NPI:1316364722
Name:JONES, BEVERLY GAYE (LPN)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:GAYE
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 ELM RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706
Mailing Address - Country:US
Mailing Address - Phone:803-581-1554
Mailing Address - Fax:
Practice Address - Street 1:1070 HECKLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2853
Practice Address - Country:US
Practice Address - Phone:803-909-7300
Practice Address - Fax:803-909-7397
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP3004251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP30051Medicaid