Provider Demographics
NPI:1205934411
Name:JONES, NICHOLE LYNN (APRN-CRNA)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:APRN-CRNA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-388-6220
Mailing Address - Fax:304-388-3286
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-388-6220
Practice Address - Fax:304-388-3286
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN55727-CRNA367500000X
WV73567367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004346Medicaid
WVPO0289733OtherRR MEDICARE
WVPO0289733OtherRR MEDICARE