Provider Demographics
NPI:1548379746
Name:JONES, KATHLEEN SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SUE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:MOFFITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9223
Practice Address - Street 1:5950 UNIVERSITY AVE STE 260
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8234
Practice Address - Country:US
Practice Address - Phone:515-875-9192
Practice Address - Fax:515-875-9151
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-32008207R00000X
IA32008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0153213Medicaid
IA1153213Medicaid
IA26563OtherWELLMARK BLUE SHIELD
IA26563OtherWELLMARK BLUE SHIELD
IA0153213Medicaid
IA26563OtherWELLMARK BLUE SHIELD