Healthcare Provider Details

I. General information

NPI: 1841143625
Provider Name (Legal Business Name): JEAN MICHELLE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8995 W 61ST ST
TULSA OK
74131-7301
US

IV. Provider business mailing address

8995 W 61ST ST
TULSA OK
74131-7301
US

V. Phone/Fax

Practice location:
  • Phone: 918-949-5241
  • Fax:
Mailing address:
  • Phone: 918-949-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: