Provider Demographics
NPI:1346261104
Name:JONES-SHUPE, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JONES-SHUPE
Suffix:
Gender:F
Credentials:
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 491000
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1000
Mailing Address - Country:US
Mailing Address - Phone:352-315-7500
Mailing Address - Fax:352-360-6585
Practice Address - Street 1:101 S 11TH ST
Practice Address - Street 2:SUITE1
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5767
Practice Address - Country:US
Practice Address - Phone:352-315-7500
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 699792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health