Healthcare Provider Details

I. General information

NPI: 1194688838
Provider Name (Legal Business Name): JAMIE LYNN SUDKAMP JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CIVIC CENTER LN
LAKE HAVASU CITY AZ
86403-5683
US

IV. Provider business mailing address

101 CIVIC CENTER LN
LAKE HAVASU CITY AZ
86403-5683
US

V. Phone/Fax

Practice location:
  • Phone: 928-453-0818
  • Fax:
Mailing address:
  • Phone: 928-453-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025097444
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number237719
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: