Healthcare Provider Details

I. General information

NPI: 1992135628
Provider Name (Legal Business Name): KYLE JONES APRN-CRNA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 S SOONER RD
MIDWEST CITY OK
73110-2668
US

IV. Provider business mailing address

1120 GLENWOOD AVE
NICHOLS HILLS OK
73116-6207
US

V. Phone/Fax

Practice location:
  • Phone: 904-626-7750
  • Fax:
Mailing address:
  • Phone: 405-438-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number86110
License Number StateOK

VIII. Authorized Official

Name: KYLE R JONES
Title or Position: PRESIDENT
Credential: CRNA
Phone: 405-408-9274