Provider Demographics
NPI:1295039931
Name:JONES, KENNEATA LASHAWN
Entity Type:Individual
Prefix:MRS
First Name:KENNEATA
Middle Name:LASHAWN
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 1:4300 S HARVARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2608
Mailing Address - Country:US
Mailing Address - Phone:918-584-0099
Mailing Address - Fax:918-587-9286
Practice Address - Street 1:4300 S HARVARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2608
Practice Address - Country:US
Practice Address - Phone:918-584-0099
Practice Address - Fax:918-587-9286
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21144171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator