Basic Information
| Provider Information | |||||||||
| NPI: | 1235645227 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | KAYTLYN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | KAYTLYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19563 HIGHLAND RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995778595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654562503 | ||||||||
| FaxNumber: | 8654562503 | ||||||||
| Practice Location | |||||||||
| Address1: | 16941 N EAGLE RIVER LOOP RD STE 3 | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995777824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077265330 | ||||||||
| FaxNumber: | 9077265330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2017 | ||||||||
| LastUpdateDate: | 12/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | AK | Y |
No ID Information.