Provider Demographics
NPI:1457612533
Name:JONES, ANDRE BYRON (PEER REC SUP SPEC)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:BYRON
Last Name:JONES
Suffix:
Gender:M
Credentials:PEER REC SUP SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 NE 55TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-6705
Mailing Address - Country:US
Mailing Address - Phone:405-427-0511
Mailing Address - Fax:
Practice Address - Street 1:1329 NE 55TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-6705
Practice Address - Country:US
Practice Address - Phone:405-427-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245OtherOKLAHOMA DEPARTMENT OF MENTAL HEALTH