=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376409714
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS BROOKE JONES PHD, MLS(ASCP)CM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5519 HIGHWAY 28 W
-----------------------------------------------------
City | ADAIR
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74330-2883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-809-9527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5519 HIGHWAY 28 W
-----------------------------------------------------
City | ADAIR
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74330-2883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-809-9527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RM2200X
-----------------------------------------------------
Taxonomy Name | Medical Laboratory Technician
-----------------------------------------------------
License Number | 246901
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------