Basic Information
Provider Information
NPI: 1669044368
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: AMY
MiddleName: MILLER
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1370 W D ST
Address2:  
City: NORTH WILKESBORO
State: NC
PostalCode: 286593506
CountryCode: US
TelephoneNumber: 3366518100
FaxNumber:  
Practice Location
Address1: 336 DEERFIELD RD
Address2:  
City: BOONE
State: NC
PostalCode: 286075008
CountryCode: US
TelephoneNumber: 8282624100
FaxNumber: 8282624103
Other Information
ProviderEnumerationDate: 07/13/2021
LastUpdateDate: 09/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X288248NCN Nursing Service ProvidersRegistered Nurse 
367500000X6820NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


Home