Healthcare Provider Details

I. General information

NPI: 1073788790
Provider Name (Legal Business Name): SUSAN K JONES SUSAN JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN BLACKBURN SUSAN JONES

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NW EXPRESSWAY BLDG. C SUITE 602
OKLAHOMA CITY OK
73112-4493
US

IV. Provider business mailing address

3400 NW EXPRESSWAY BLDG. C SUITE 602
OKLAHOMA CITY OK
73112-4493
US

V. Phone/Fax

Practice location:
  • Phone: 405-951-8214
  • Fax: 405-951-8183
Mailing address:
  • Phone: 405-951-8214
  • Fax: 405-951-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberR0039104
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberR0039104
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: