Basic Information
| Provider Information | |||||||||
| NPI: | 1154370864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | PERRY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GUNNING | ||||||||
| OtherFirstName: | REGINA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5700 CLEVELAND STREET | ||||||||
| Address2: | SUITE 228 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234621752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574992825 | ||||||||
| FaxNumber: | 7574994248 | ||||||||
| Practice Location | |||||||||
| Address1: | 612 KINGSBOROUGH SQUARE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233205041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575479294 | ||||||||
| FaxNumber: | 7575480092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024165182 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1154370864 | 05 | VA | MEDICAID | 10012986P | 01 | VA | OPTIMA/SENTARA | OTHER |