Basic Information
| Provider Information | |||||||||
| NPI: | 1811516289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STONE | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 BLUE MOUNTAIN DR | ||||||||
| Address2: | |||||||||
| City: | MAUMELLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721136397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014164050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 STANTON L YOUNG BLVD STE 3440 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052718001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2020 | ||||||||
| LastUpdateDate: | 11/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 36043 | OK | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208D00000X | 36043 | OK | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | 36043 | OK | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.