Provider Demographics
NPI:1851857692
Name:JONES, ALICIA (RN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 KODIAK DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8056
Mailing Address - Country:US
Mailing Address - Phone:919-395-9706
Mailing Address - Fax:
Practice Address - Street 1:2421 KODIAK DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8056
Practice Address - Country:US
Practice Address - Phone:919-395-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse