Provider Demographics
NPI:1972139830
Name:JONES, VANESSA M (RN,MINISTER,HERBALIS)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:RN,MINISTER,HERBALIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 MEADOWLAKE DR
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-6656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5511 MEADOWLAKE DR
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6656
Practice Address - Country:US
Practice Address - Phone:405-826-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-22
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101412163W00000X
175L00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No163W00000XNursing Service ProvidersRegistered Nurse
No175L00000XOther Service ProvidersHomeopath