Provider Demographics
NPI:1518771393
Name:GATHERS, JESAKAH RAE
Entity type:Individual
Prefix:
First Name:JESAKAH
Middle Name:RAE
Last Name:GATHERS
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 61
Mailing Address - Street 2:
Mailing Address - City:BINGER
Mailing Address - State:OK
Mailing Address - Zip Code:73009-0061
Mailing Address - Country:US
Mailing Address - Phone:405-234-7972
Mailing Address - Fax:
Practice Address - Street 1:300 N MERIDIAN AVE STE 201N
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6553
Practice Address - Country:US
Practice Address - Phone:405-601-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator