Provider Demographics
NPI:1417990508
Name:JONES, PORTIA KAM (CRNFA)
Entity Type:Individual
Prefix:
First Name:PORTIA
Middle Name:KAM
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 E 3900 S
Mailing Address - Street 2:#5000
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1275
Mailing Address - Country:US
Mailing Address - Phone:801-262-8486
Mailing Address - Fax:801-262-9752
Practice Address - Street 1:1160 E 3900 S
Practice Address - Street 2:#5000
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1275
Practice Address - Country:US
Practice Address - Phone:801-262-8486
Practice Address - Fax:801-262-9752
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT202780-3102163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT701OtherORTHPHYASST
UT985721OtherCRNFA
UT000055905Medicare PIN