Provider Demographics
NPI:1740761782
Name:JONES, LITA CARLENE
Entity Type:Individual
Prefix:
First Name:LITA
Middle Name:CARLENE
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 1:1680 S GREATHOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:75452
Mailing Address - Country:US
Mailing Address - Phone:580-889-3553
Mailing Address - Fax:580-889-4050
Practice Address - Street 1:1680 S GREATHOUSE DRIVE
Practice Address - Street 2:1680 S GREATHOUSE DRIVE
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525
Practice Address - Country:US
Practice Address - Phone:580-889-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker