Provider Demographics
NPI:1972229987
Name:JONES, KATHERINE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAINT ELIZABETH BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1281
Mailing Address - Country:US
Mailing Address - Phone:618-641-5803
Mailing Address - Fax:618-607-5116
Practice Address - Street 1:3 SAINT ELIZABETH BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1281
Practice Address - Country:US
Practice Address - Phone:618-641-5803
Practice Address - Fax:618-607-5116
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041511541163W00000X
IL209026207363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse