Provider Demographics
NPI:1538696414
Name:JONES REITER, MELISSA SHELBY
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SHELBY
Last Name:JONES REITER
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 1:9812 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2410
Mailing Address - Country:US
Mailing Address - Phone:405-641-1173
Mailing Address - Fax:
Practice Address - Street 1:502 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4216
Practice Address - Country:US
Practice Address - Phone:918-649-7065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKT082977139171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator