Provider Demographics
NPI:1972105021
Name:JONES, THERESA DAWN
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:DAWN
Last Name:JONES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:FORMBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36609 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-8882
Mailing Address - Country:US
Mailing Address - Phone:405-273-1170
Mailing Address - Fax:405-275-5132
Practice Address - Street 1:1010 E 45TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2202
Practice Address - Country:US
Practice Address - Phone:140-569-4966
Practice Address - Fax:405-214-4412
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist