Healthcare Provider Details

I. General information

NPI: 1699529107
Provider Name (Legal Business Name): CHRISTINA MARIE JONES DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 FAIRVIEW AVE STE 230
CALDWELL ID
83605-5432
US

IV. Provider business mailing address

PO BOX 277976
ATLANTA GA
30384-6035
US

V. Phone/Fax

Practice location:
  • Phone: 208-459-4667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4161676
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: