Provider Demographics
NPI:1275994576
Name:JARNAGIN, LESIA
Entity Type:Individual
Prefix:
First Name:LESIA
Middle Name:
Last Name:JARNAGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10970 COUNTY ROAD 240
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-9128
Mailing Address - Country:US
Mailing Address - Phone:417-396-2951
Mailing Address - Fax:
Practice Address - Street 1:10970 COUNTY ROAD 240
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-9128
Practice Address - Country:US
Practice Address - Phone:417-396-2951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator