Provider Demographics
NPI:1649706771
Name:JAMES, LEISA
Entity type:Individual
Prefix:
First Name:LEISA
Middle Name:
Last Name:JAMES
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 1:401 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-0000
Mailing Address - Country:US
Mailing Address - Phone:918-337-8080
Mailing Address - Fax:918-777-9018
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-0000
Practice Address - Country:US
Practice Address - Phone:918-337-8080
Practice Address - Fax:918-777-9018
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator