Provider Demographics
NPI:1568120749
Name:JONES, KATRENA
Entity Type:Individual
Prefix:
First Name:KATRENA
Middle Name:
Last Name:JONES
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 1:3108 HIGH GLEN DR APT F
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-9719
Mailing Address - Country:US
Mailing Address - Phone:704-726-6363
Mailing Address - Fax:
Practice Address - Street 1:3108 HIGH GLEN DR APT F
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-9719
Practice Address - Country:US
Practice Address - Phone:704-726-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor