Provider Demographics
NPI:1447872502
Name:JONES, KATIE LEE (RN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 W BELLTOWER DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4882
Mailing Address - Country:US
Mailing Address - Phone:208-996-0099
Mailing Address - Fax:
Practice Address - Street 1:3142 W BELLTOWER DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4882
Practice Address - Country:US
Practice Address - Phone:208-996-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN32194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse