Healthcare Provider Details

I. General information

NPI: 1720090400
Provider Name (Legal Business Name): CAROLYN J JONES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN J BELLAMAH APRN

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST
MISSOULA MT
59802-4008
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-329-5615
  • Fax: 406-329-5606
Mailing address:
  • Phone: 406-329-5615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27917
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNUR-APRN-LIC-100490
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: