Provider Demographics
NPI:1821118845
Name:KING, KASSITY LAURAN (BS CM)
Entity Type:Individual
Prefix:MRS
First Name:KASSITY
Middle Name:LAURAN
Last Name:KING
Suffix:
Gender:F
Credentials:BS CM
Other - Prefix:MS
Other - First Name:KASSITY
Other - Middle Name:LAURAN
Other - Last Name:JARNAGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS CM
Mailing Address - Street 1:909 ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5229
Mailing Address - Country:US
Mailing Address - Phone:405-573-3994
Mailing Address - Fax:405-573-8245
Practice Address - Street 1:909 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5229
Practice Address - Country:US
Practice Address - Phone:405-573-3994
Practice Address - Fax:405-573-8245
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10295171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator