Provider Demographics
NPI:1770166498
Name:JONES FAMILY PRACTICE CLINIC
Entity type:Organization
Organization Name:JONES FAMILY PRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:APRN
Authorized Official - Phone:918-912-5372
Mailing Address - Street 1:1118 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6246
Mailing Address - Country:US
Mailing Address - Phone:918-912-5372
Mailing Address - Fax:918-912-5373
Practice Address - Street 1:1118 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6246
Practice Address - Country:US
Practice Address - Phone:918-912-5372
Practice Address - Fax:918-912-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty