Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 14383 | TN |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP60691562 | WA |
NPI | 1043546021 |
---|---|
Provider Name | Kalli M Jones |
First Address | Port Angeles, WA 98363-9510 |
Second Address | Port Angeles, WA 98363-9510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2009 |
Last Update Date | 28/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1516075 | (05) | TN |