Provider Demographics
NPI:1023725561
Name:JONES, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
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 1:3603 S BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-5447
Mailing Address - Country:US
Mailing Address - Phone:580-889-6459
Mailing Address - Fax:580-889-6518
Practice Address - Street 1:3603 S BLACKBERRY LN
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-5447
Practice Address - Country:US
Practice Address - Phone:580-889-6459
Practice Address - Fax:580-889-6518
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100683770Medicaid