Provider Demographics
NPI:1043546021
Name:JONES, KALLI M (CPNP)
Entity Type:Individual
Prefix:
First Name:KALLI
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KALLI
Other - Middle Name:M
Other - Last Name:KONOPASKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2844 W EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-9510
Mailing Address - Country:US
Mailing Address - Phone:360-460-9493
Mailing Address - Fax:
Practice Address - Street 1:2844 W EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-9510
Practice Address - Country:US
Practice Address - Phone:360-460-9493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14383363LP0200X
WAAP60691562363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516075Medicaid