Provider Demographics
NPI:1790339372
Name:JONES-WALLER, SKYE
Entity Type:Individual
Prefix:MRS
First Name:SKYE
Middle Name:
Last Name:JONES-WALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SKYE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1805 COLUMBIA RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2001
Mailing Address - Country:US
Mailing Address - Phone:888-805-4551
Mailing Address - Fax:
Practice Address - Street 1:1805 COLUMBIA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2001
Practice Address - Country:US
Practice Address - Phone:888-805-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218382163WM0705X, 363LF0000X
VA0024186891363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program