=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982830345
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHELLE JONES F.N.P.-C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2009
-----------------------------------------------------
Last Update Date | 11/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 556 TREJO ST STE B
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-881-0902
-----------------------------------------------------
Fax | 208-881-9352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 556 TREJO ST STE B
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-881-0902
-----------------------------------------------------
Fax | 208-881-9352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 20125A
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------