Provider Demographics
NPI:1053712885
Name:JONES, TAWATHA DOMINIQUE
Entity type:Individual
Prefix:MRS
First Name:TAWATHA
Middle Name:DOMINIQUE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAWATHA
Other - Middle Name:DOMINIQUE
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:721 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:721 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3405
Practice Address - Country:US
Practice Address - Phone:918-780-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator