Provider Demographics
NPI:1215308283
Name:JONES, KAYCE NICHOLS (PA)
Entity type:Individual
Prefix:
First Name:KAYCE
Middle Name:NICHOLS
Last Name:JONES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAYCE
Other - Middle Name:ALEXANDRA
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2053
Mailing Address - Country:US
Mailing Address - Phone:318-259-1569
Mailing Address - Fax:318-259-8523
Practice Address - Street 1:2120 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3106
Practice Address - Country:US
Practice Address - Phone:318-742-6900
Practice Address - Fax:318-742-3900
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA300212363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA300212OtherLICENSE #