Provider Demographics
NPI:1629174636
Name:JONES, REBECCA GAIL (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:GAIL
Last Name:JONES
Suffix:
Gender:F
Credentials:ARNP
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 501
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29146-0501
Mailing Address - Country:US
Mailing Address - Phone:803-447-1036
Mailing Address - Fax:
Practice Address - Street 1:121 CLEMSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-6545
Practice Address - Country:US
Practice Address - Phone:803-447-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2970912363L00000X
SC2773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ59107Medicare UPIN