Individual
LEAH KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4 E CLARK BASS BLVD STE 205, MCALESTER, OK 74501-4285
(918) 421-8897
(918) 302-0825
Mailing address
4 E CLARK BASS BLVD STE 205, MCALESTER, OK 74501-4285
(918) 421-8897
(918) 302-0825
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
N081495759
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100736010A
—
OK
Enumeration date
05/04/2016
Last updated
05/04/2016
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