Provider Demographics
NPI:1154370864
Name:JONES, REGINA PERRY (NPC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:PERRY
Last Name:JONES
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:GUNNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5700 CLEVELAND STREET
Mailing Address - Street 2:SUITE 228
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1752
Mailing Address - Country:US
Mailing Address - Phone:757-499-2825
Mailing Address - Fax:757-499-4248
Practice Address - Street 1:612 KINGSBOROUGH SQUARE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5041
Practice Address - Country:US
Practice Address - Phone:757-547-9294
Practice Address - Fax:757-548-0092
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1154370864Medicaid
VA10012986POtherOPTIMA/SENTARA
Q68133Medicare UPIN
VA010118C92Medicare PIN