Healthcare Provider Details

I. General information

NPI: 1306148895
Provider Name (Legal Business Name): KYLE ROSS JONES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 GLENWOOD AVE
NICHOLS HILLS OK
73116-6207
US

IV. Provider business mailing address

1120 GLENWOOD AVE
NICHOLS HILLS OK
73116-6207
US

V. Phone/Fax

Practice location:
  • Phone: 405-408-9274
  • Fax:
Mailing address:
  • Phone: 405-408-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number100377
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0100377
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: