Healthcare Provider Details

I. General information

NPI: 1194693689
Provider Name (Legal Business Name): JOSHUA JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 NEPTUNE DR
IDAHO FALLS ID
83402-2317
US

IV. Provider business mailing address

689 NEPTUNE DR
IDAHO FALLS ID
83402-2317
US

V. Phone/Fax

Practice location:
  • Phone: 208-680-9766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9481701
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: