Basic Information
| Provider Information | |||||||||
| NPI: | 1497974281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JESTER | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | CLAIRE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1354 | ||||||||
| Address2: | |||||||||
| City: | PURCELL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730801354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5807161032 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4720 S SHIELDS BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731293210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056321900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 03/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.