Provider Demographics
NPI:1508281924
Name:KING, JESA LEIGH
Entity type:Individual
Prefix:MRS
First Name:JESA
Middle Name:LEIGH
Last Name:KING
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-0189
Mailing Address - Country:US
Mailing Address - Phone:580-319-7305
Mailing Address - Fax:
Practice Address - Street 1:209 E WILSON ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2200
Practice Address - Country:US
Practice Address - Phone:580-371-3019
Practice Address - Fax:580-371-0139
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2025-10-24
Deactivation Date:2021-03-26
Deactivation Code:
Reactivation Date:2025-10-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator