Provider Demographics
NPI:1679585434
Name:JONES, CHERYL PATRICIA (PA)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:PATRICIA
Last Name:JONES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 BANKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-6961
Mailing Address - Country:US
Mailing Address - Phone:313-516-3550
Mailing Address - Fax:252-243-1347
Practice Address - Street 1:1806 GLENDALE DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4402
Practice Address - Country:US
Practice Address - Phone:252-243-0566
Practice Address - Fax:252-243-1347
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002530363A00000X
NC0010-05185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC189AAOtherBCBSNC
NC1679585434OtherFIRST HEALTH
NC1679585434Medicaid
NC286534OtherMEDCOST
NC286534OtherMEDCOST