Provider Demographics
NPI:1184986101
Name:JONES, JAMES LEWIS JR (ACNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEWIS
Last Name:JONES
Suffix:JR
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-0529
Mailing Address - Country:US
Mailing Address - Phone:208-851-0460
Mailing Address - Fax:
Practice Address - Street 1:550 E 1400 N
Practice Address - Street 2:SUITE J
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2406
Practice Address - Country:US
Practice Address - Phone:435-753-1171
Practice Address - Fax:435-792-4464
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8298298-4408363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care