Healthcare Provider Details

I. General information

NPI: 1003782871
Provider Name (Legal Business Name): COURTNI LEE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E 17TH ST STE D
IDAHO FALLS ID
83404-8042
US

IV. Provider business mailing address

689 NEPTUNE DR
IDAHO FALLS ID
83402-2317
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-0747
  • Fax: 855-830-4276
Mailing address:
  • Phone: 208-419-9823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7281603
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: