Provider Demographics
NPI:1881600914
Name:JONES, JIMMY LEE (ANP)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 N LAFAYETTE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3834
Mailing Address - Country:US
Mailing Address - Phone:704-487-9766
Mailing Address - Fax:704-487-9891
Practice Address - Street 1:1019 N LAFAYETTE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3834
Practice Address - Country:US
Practice Address - Phone:704-487-9766
Practice Address - Fax:704-487-9891
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
561884447OtherGROUP
2321972Medicare ID - Type UnspecifiedGROUP
2809335HMedicare ID - Type Unspecified
P97124Medicare UPIN