Healthcare Provider Details

I. General information

NPI: 1760445134
Provider Name (Legal Business Name): JUANITA J JONES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 NW 23RD ST
OKLAHOMA CITY OK
73103-1508
US

IV. Provider business mailing address

416 NW 23RD ST
OKLAHOMA CITY OK
73103-1508
US

V. Phone/Fax

Practice location:
  • Phone: 405-279-7169
  • Fax: 405-402-1230
Mailing address:
  • Phone: 405-279-7169
  • Fax: 405-402-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number125657
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number205100
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: