Provider Demographics
NPI:1750090320
Name:STOOKEY, JODIE KAYE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:KAYE
Last Name:STOOKEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4263 E HAZELWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-1212
Mailing Address - Country:US
Mailing Address - Phone:870-589-1755
Mailing Address - Fax:
Practice Address - Street 1:2001 S WOODRUFF AVE STE 15B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6372
Practice Address - Country:US
Practice Address - Phone:208-357-4633
Practice Address - Fax:208-419-0690
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60231755163W00000X
WAAP61380253363LF0000X
WAARNP61380253363LF0000X
ID75715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse