Provider Demographics
NPI:1619051075
Name:JONES, KATHY Y (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:Y
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
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 470308
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-0308
Mailing Address - Country:US
Mailing Address - Phone:407-228-8066
Mailing Address - Fax:407-228-8438
Practice Address - Street 1:2501 N ORANGE AVE STE 309
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4642
Practice Address - Country:US
Practice Address - Phone:407-228-8066
Practice Address - Fax:407-228-8438
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0078870207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259275400Medicaid
FLME0078870OtherMEDICAL LICENSE
FLME0078870OtherMEDICAL LICENSE
FLBJ4581321OtherDEA
FL49387ZMedicare PIN
FL753060396OtherTIN