Provider Demographics
NPI:1396350559
Name:JONES, AMANDA KATHRYN (CNM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHRYN
Last Name:JONES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVE SUITE 130
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-286-6565
Mailing Address - Fax:336-286-6566
Practice Address - Street 1:3200 NORTHLINE AVE STE 130
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7600
Practice Address - Country:US
Practice Address - Phone:336-286-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24297367A00000X
NCCNM779176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ692823365OtherMEDICARE PIN
SCNP7116Medicaid