MEDICARE: KYLE ROSS JONES CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	100377	OK
2	367500000X	Certified Registered Nurse Anesthetist	R0100377	OK

General Provider Information

NPI Number	:	1306148895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ROSS JONES CRNA

Provider Business Mailing Address
First Line	:	1120 GLENWOOD AVE
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6207
Country	:	US
Telephone Number	:	405-408-9274
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 GLENWOOD AVE
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6207
Country	:	US
Telephone Number	:	405-408-9274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2010
Last Update Date	:	02/18/2021

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