Individual
MCKAYLA RAE JONES CLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
106 S CLAUDE A LORD BLVD, POTTSVILLE, PA 17901-3639
(570) 728-2424
Mailing address
1967 HOWARD AVE, POTTSVILLE, PA 17901-3217
(570) 294-8630
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA063463
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA063463
PHYSICIAN ASSISTANT LICENSE
PA
Enumeration date
05/17/2022
Last updated
10/25/2022
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