Provider Demographics
NPI:1922561760
Name:JONES, KATIE NICOLE (RD, LMNT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4465
Mailing Address - Country:US
Mailing Address - Phone:402-413-3939
Mailing Address - Fax:
Practice Address - Street 1:5633 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4465
Practice Address - Country:US
Practice Address - Phone:402-413-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE86003667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered