1194084269 NPI number — DR. ALLYCE KATIE JONES PMHNP-BC, APRN

Table of content: DR. ALLYCE KATIE JONES PMHNP-BC, APRN (NPI 1194084269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194084269 NPI number — DR. ALLYCE KATIE JONES PMHNP-BC, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
ALLYCE
Provider Middle Name:
KATIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194084269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1309 W SOUTH JORDAN PKWY STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-9002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-893-9564
Provider Business Mailing Address Fax Number:
801-893-9062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1309 W SOUTH JORDAN PKWY STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-893-9564
Provider Business Practice Location Address Fax Number:
801-893-9062
Provider Enumeration Date:
05/10/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  7935706-4405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)