Healthcare Provider Details

I. General information

NPI: 1659687887
Provider Name (Legal Business Name): KATHRYN L JONES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN RANNALS

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5470
  • Fax: 505-913-6489
Mailing address:
  • Phone: 505-913-5470
  • Fax: 505-913-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP - 01646
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: