Healthcare Provider Details

I. General information

NPI: 1356993448
Provider Name (Legal Business Name): EDITH KATHLEEN JONES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 GREATLAND ST
HOMER AK
99603-7522
US

IV. Provider business mailing address

4300 BARTLETT ST
HOMER AK
99603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-7202
  • Fax: 907-435-3053
Mailing address:
  • Phone: 907-235-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number241454
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024177819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: