Provider Demographics
NPI:1306049721
Name:POWELL, JON HARRISON
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:HARRISON
Last Name:POWELL
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 1:4712 E 80TH ST
Mailing Address - Street 2:APARTMENT 15P
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8950
Mailing Address - Country:US
Mailing Address - Phone:918-551-6051
Mailing Address - Fax:918-494-9870
Practice Address - Street 1:7010 S YALE AVE STE 215
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5743
Practice Address - Country:US
Practice Address - Phone:918-492-2554
Practice Address - Fax:918-494-9870
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator