Provider Demographics
NPI:1396710745
Name:JONES, PHYLLIS (CRNP)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3825
Mailing Address - Country:US
Mailing Address - Phone:919-833-3111
Mailing Address - Fax:919-340-0271
Practice Address - Street 1:111 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2501
Practice Address - Country:US
Practice Address - Phone:919-833-3111
Practice Address - Fax:919-340-0271
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093435363LF0000X
NC290247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
6033167001OtherCIGNA
60851801OtherCAREFIRST
0011OtherCAREFIRST
MD345202600Medicaid
MD345202600Medicaid
006098A94Medicare ID - Type Unspecified
0011OtherCAREFIRST