Basic Information
| Provider Information | |||||||||
| NPI: | 1003010307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STONE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 SYDNEY ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322058019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364204028 | ||||||||
| FaxNumber: | 2525376851 | ||||||||
| Practice Location | |||||||||
| Address1: | 1385 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278705130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525379176 | ||||||||
| FaxNumber: | 2525376851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME111724 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2007-00575 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.