Provider Demographics
NPI:1073788790
Name:JONES, SUSAN K (SUSAN JONES)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:JONES
Suffix:
Gender:F
Credentials:SUSAN JONES
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUSAN JONES
Mailing Address - Street 1:3400 NW EXPRESSWAY
Mailing Address - Street 2:BLDG. C SUITE 602
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4493
Mailing Address - Country:US
Mailing Address - Phone:405-951-8214
Mailing Address - Fax:405-951-8183
Practice Address - Street 1:3400 NW EXPRESSWAY
Practice Address - Street 2:BLDG. C SUITE 602
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4493
Practice Address - Country:US
Practice Address - Phone:405-951-8214
Practice Address - Fax:405-951-8183
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0039104364SA2100X, 364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics