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General NPI Number Information
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NPI Number | 1336006840
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Entity Type | Individual
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Provider Name | CRISTEN DOUGLAS-MALLARI JONES JR.
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Gender | Male
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 1111 W 17TH ST
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City | TULSA
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State | OK
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Zip | 74107-1886
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Country | US
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Telephone | 918-561-8324
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Fax |
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Provider Business Mailing Address
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Address Line | 140 EDGEWOOD CIR
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City | DURANT
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State | OK
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Zip | 74701-7044
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Country | US
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Telephone | 580-816-1449
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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