Provider Demographics
NPI:1417381161
Name:JONES, CARLYN AURELIA
Entity type:Individual
Prefix:
First Name:CARLYN
Middle Name:AURELIA
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 WESLEYAN DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6906
Mailing Address - Country:US
Mailing Address - Phone:757-395-1900
Mailing Address - Fax:757-995-7373
Practice Address - Street 1:5460 WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6906
Practice Address - Country:US
Practice Address - Phone:757-395-1900
Practice Address - Fax:757-995-7373
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Y00000X
VA0110007905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist