Provider Demographics
NPI:1598197287
Name:KING, JORDON DAWN (BA LIBERAL ARTS)
Entity type:Individual
Prefix:MRS
First Name:JORDON
Middle Name:DAWN
Last Name:KING
Suffix:
Gender:F
Credentials:BA LIBERAL ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24972 S HEARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-0848
Mailing Address - Country:US
Mailing Address - Phone:918-902-0455
Mailing Address - Fax:
Practice Address - Street 1:24972 S HEARTWOOD DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-0848
Practice Address - Country:US
Practice Address - Phone:918-902-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator