Provider Demographics
NPI:1356891782
Name:JONES, DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:DILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 N EAGLE CREEK DR
Mailing Address - Street 2:STE 120
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:859-275-4878
Mailing Address - Fax:859-276-5400
Practice Address - Street 1:101 N EAGLE CREEK DR
Practice Address - Street 2:STE 120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-275-4878
Practice Address - Fax:859-276-5400
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC537363A00000X
KYPA2148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100445340Medicaid