Provider Demographics
NPI:1518903194
Name:GUTHRIE-JONES, MARY L (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:GUTHRIE-JONES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 RED CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523-9515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1505 NW WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1049
Practice Address - Country:US
Practice Address - Phone:541-956-6250
Practice Address - Fax:541-956-6251
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3920P363L00000X
OR81002128N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78009446Medicaid
KY3920POtherKENTUCKY
OR81002128N1OtherOREGON
OR81002128N1OtherOREGON
KY78009446Medicaid
0623627Medicare PIN