Provider Demographics
NPI:1205180270
Name:JONES, MADELYNE KAY
Entity Type:Individual
Prefix:
First Name:MADELYNE
Middle Name:KAY
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 S. YALE AVE., SUITE 1200
Mailing Address - Street 2:GASTROENTEROLOGY SPECIALISTS INC.
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74138-8313
Mailing Address - Country:US
Mailing Address - Phone:918-494-9433
Mailing Address - Fax:918-494-9499
Practice Address - Street 1:6565 S. YALE AVE., SUITE 1200
Practice Address - Street 2:GASTROENTEROLOGY SPECIALISTS INC.
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74138-8313
Practice Address - Country:US
Practice Address - Phone:918-494-9433
Practice Address - Fax:918-494-9499
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6775691133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist