Provider Demographics
NPI:1043025505
Name:JONES, SYDNEY WITHERSPOON
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:WITHERSPOON
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 1:306 HIDDEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-5611
Mailing Address - Country:US
Mailing Address - Phone:423-956-9228
Mailing Address - Fax:
Practice Address - Street 1:2428 KNOB CREEK RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2397
Practice Address - Country:US
Practice Address - Phone:423-282-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37684363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner