Provider Demographics
NPI:1750900320
Name:JONES, BRANDY ANN (ADULT-GERONTOLOGY NP)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:ADULT-GERONTOLOGY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 POLE LINE RD W # 115
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5860
Mailing Address - Country:US
Mailing Address - Phone:208-814-8293
Mailing Address - Fax:
Practice Address - Street 1:775 POLE LINE RD W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5814
Practice Address - Country:US
Practice Address - Phone:208-814-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID64556363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care