Provider Demographics
NPI:1881870863
Name:JONES, KIMBERLY (PA-C)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SEALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1404
Mailing Address - Country:US
Mailing Address - Phone:859-277-5887
Mailing Address - Fax:859-276-7659
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 601
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-277-5887
Practice Address - Fax:859-276-7659
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0783606Medicare PIN