Provider Demographics
NPI:1821569716
Name:JONES, KEILAH WYNN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:KEILAH
Middle Name:WYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:JULIETTE
Mailing Address - State:GA
Mailing Address - Zip Code:31046-3910
Mailing Address - Country:US
Mailing Address - Phone:478-719-9013
Mailing Address - Fax:
Practice Address - Street 1:550 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1411
Practice Address - Country:US
Practice Address - Phone:478-741-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227869363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics