Provider Demographics
NPI:1104042563
Name:JESTES, RONNIE E (CADC)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:E
Last Name:JESTES
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45470 S 349 RD
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-1060
Mailing Address - Country:US
Mailing Address - Phone:918-762-3851
Mailing Address - Fax:
Practice Address - Street 1:600 DENVER ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-3522
Practice Address - Country:US
Practice Address - Phone:918-762-3686
Practice Address - Fax:915-762-2617
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK65101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)