Provider Demographics
NPI:1346243433
Name:JONES, POLLY C (PA-C)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:C
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:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1988
Mailing Address - Country:US
Mailing Address - Phone:606-439-1300
Mailing Address - Fax:606-439-1400
Practice Address - Street 1:145 CITIZENS LN
Practice Address - Street 2:SUITE B
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1320
Practice Address - Country:US
Practice Address - Phone:606-439-1300
Practice Address - Fax:606-439-1400
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000588185OtherANTHEM BC/BS-HYDEN OFFICE
KY000000588457OtherANTHEM BC/BS-VICCO OFFICE
KY000000588455OtherANTHEM BC/BS-HAZARD OFFICE
KY95000329Medicaid
KY000000588457OtherANTHEM BC/BS-VICCO OFFICE
KY0984413Medicare PIN
KY0076323Medicare PIN
KY000000588455OtherANTHEM BC/BS-HAZARD OFFICE
KY00051014Medicare PIN
KY1371414Medicare ID - Type Unspecified