Provider Demographics
NPI:1679071542
Name:JONES, PATRICIA KIRKLEY (DNP-FNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KIRKLEY
Last Name:JONES
Suffix:
Gender:F
Credentials:DNP-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 NAPA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0359
Mailing Address - Country:US
Mailing Address - Phone:803-246-8414
Mailing Address - Fax:
Practice Address - Street 1:2419 NAPA VALLEY DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0359
Practice Address - Country:US
Practice Address - Phone:803-246-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21667363LF0000X
NC5013942363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3471421101Medicaid