Healthcare Provider Details

I. General information

NPI: 1396107066
Provider Name (Legal Business Name): HEATHER ANNE JONES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16414 W 760 RD
TAHLEQUAH OK
74464-1675
US

IV. Provider business mailing address

4741 W OKMULGEE ST
MUSKOGEE OK
74401-4657
US

V. Phone/Fax

Practice location:
  • Phone: 918-561-8428
  • Fax:
Mailing address:
  • Phone: 918-348-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number6197
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: