Provider Demographics
NPI:1306148895
Name:JONES, KYLE ROSS (CRNA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ROSS
Last Name:JONES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-6207
Mailing Address - Country:US
Mailing Address - Phone:405-408-9274
Mailing Address - Fax:
Practice Address - Street 1:1120 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73116-6207
Practice Address - Country:US
Practice Address - Phone:405-408-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100377163W00000X
OKR0100377367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty