Healthcare Provider Details

I. General information

NPI: 1346181385
Provider Name (Legal Business Name): ELIZABETH JEAN KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N UNION AVE
SHAWNEE OK
74801
US

IV. Provider business mailing address

2801 UNION ST
SHAWNEE OK
74804
US

V. Phone/Fax

Practice location:
  • Phone: 405-275-1844
  • Fax:
Mailing address:
  • Phone: 405-339-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: