Healthcare Provider Details

I. General information

NPI: 1790339372
Provider Name (Legal Business Name): MRS. SKYE JONES-WALLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SKYE JONES CRNP

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 COLUMBIA RD NW
WASHINGTON DC
20009-2001
US

IV. Provider business mailing address

1101 WILSON BLVD FL 6
ARLINGTON VA
22209-2281
US

V. Phone/Fax

Practice location:
  • Phone: 888-805-4551
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR218382
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR218382
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024186891
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: