Provider Demographics
NPI:1053877084
Name:JONES, STEPHANIE TYNER (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TYNER
Last Name:JONES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3602
Mailing Address - Country:US
Mailing Address - Phone:910-640-6615
Mailing Address - Fax:910-640-1088
Practice Address - Street 1:304 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3602
Practice Address - Country:US
Practice Address - Phone:910-640-6615
Practice Address - Fax:910-640-1088
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner