Provider Demographics
NPI:1376058024
Name:JONES, KERRI MICHELE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KERRI
Middle Name:MICHELE
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:MICHELE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL STE 108
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7522
Mailing Address - Country:US
Mailing Address - Phone:919-784-2300
Mailing Address - Fax:919-784-2301
Practice Address - Street 1:4414 LAKE BOONE TRL STE 108
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7522
Practice Address - Country:US
Practice Address - Phone:919-784-2300
Practice Address - Fax:919-784-2301
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07725363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical