Provider Demographics
NPI:1639570153
Name:YANKES, JONATHAN SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:YANKES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SKY SAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 AIRPORT RD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1604
Practice Address - Country:US
Practice Address - Phone:252-522-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant