Provider Demographics
NPI:1447098272
Name:JONES, NOLAN RAY
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:RAY
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 S JACKSON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-3030
Mailing Address - Country:US
Mailing Address - Phone:901-283-0173
Mailing Address - Fax:
Practice Address - Street 1:2434 S JACKSON AVE APT B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-3030
Practice Address - Country:US
Practice Address - Phone:901-283-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist