Provider Demographics
NPI:1477292431
Name:JONES, KATHLEEN RAE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RAE
Last Name:JONES
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:168-988-4882
Mailing Address - Fax:216-362-0677
Practice Address - Street 1:12380 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1043
Practice Address - Country:US
Practice Address - Phone:168-988-4882
Practice Address - Fax:216-362-0677
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0031472363LA2200X
TN31476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner