Provider Demographics
NPI:1972240257
Name:JONES CLOSE, MCKAYLA RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:RAE
Last Name:JONES CLOSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MCKAYLA
Other - Middle Name:RAE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1967 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3217
Mailing Address - Country:US
Mailing Address - Phone:570-294-8630
Mailing Address - Fax:
Practice Address - Street 1:106 S CLAUDE A LORD BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3639
Practice Address - Country:US
Practice Address - Phone:570-728-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063463363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA063463OtherPHYSICIAN ASSISTANT LICENSE