Provider Demographics
NPI:1760078323
Name:JONES, CARISSA TRINETTE (RN)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:TRINETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105365 S HIGHWAY 102
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-3051
Mailing Address - Country:US
Mailing Address - Phone:405-964-2081
Mailing Address - Fax:405-964-2170
Practice Address - Street 1:105365 S HIGHWAY 102
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-3051
Practice Address - Country:US
Practice Address - Phone:405-964-2081
Practice Address - Fax:405-964-2170
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0104860163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
22200767OtherCERTIFICATION BOARD FOR DIABETES CARE AND EDUCATION