Provider Demographics
NPI:1477628501
Name:JONES, PENNY LORAINE (NP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:LORAINE
Last Name:JONES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 QUAKER LN STE 100C
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-878-6027
Mailing Address - Fax:336-878-6189
Practice Address - Street 1:624 QUAKER LN
Practice Address - Street 2:SUITE 100-C
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3832
Practice Address - Country:US
Practice Address - Phone:336-878-6027
Practice Address - Fax:336-878-6189
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02411363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003911Medicaid
NC2592781AMedicare PIN