Provider Demographics
NPI:1861651770
Name:JONES, MELYNDA ANN
Entity Type:Individual
Prefix:
First Name:MELYNDA
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 SANDY RIVER LN
Mailing Address - Street 2:203
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4887
Mailing Address - Country:US
Mailing Address - Phone:843-422-6083
Mailing Address - Fax:
Practice Address - Street 1:8945 CAMDEN CREEK LN
Practice Address - Street 2:302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4908
Practice Address - Country:US
Practice Address - Phone:843-422-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC668314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility