Mykel Marie Jess

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

9236 Issued in CT

Practice address

1825 S Kimball Ave
Caldwell, ID 83605-4828

Phone

(208) 455-3535

Fax

(208) 455-5190

NPI assigned

Oct 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1275175614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 N 4TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024510",
            "telephone_number": "208-342-9800",
            "fax_number": "208-342-4223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 S KIMBALL AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054828",
            "telephone_number": "208-455-3535",
            "fax_number": "208-455-5190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "633 N 4th St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837024510",
            "country_code": "US",
            "telephone_number": "208-342-9800",
            "fax_number": "208-342-4223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JESS",
        "first_name": "MYKEL",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-16",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CT",
            "license": "9236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perry A. Jansen, M.D., MPH
• Brandon Jenkins
• Jami B Jenkins, ARNP
• Krystal Jensen
• Susan Danette Jensen, TT47289
• Uncil Grace Jo, LCSW
• Raymond Joffer, RPH
• Courtney D Johnson, LMSW
• Crystal Johnson
• Donna Jane Johnson, LMT

• Gerontology Nurse Practitioner in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Gerontology Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.