Provider Demographics
NPI:1063210805
Name:JONES, KEYANA DESIREE
Entity type:Individual
Prefix:
First Name:KEYANA
Middle Name:DESIREE
Last Name:JONES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N NUNN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2025
Mailing Address - Country:US
Mailing Address - Phone:252-571-4826
Mailing Address - Fax:
Practice Address - Street 1:105 N NUNN ST STE 2
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2025
Practice Address - Country:US
Practice Address - Phone:252-571-4826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC561988172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker