Healthcare Provider Details

I. General information

NPI: 1891219358
Provider Name (Legal Business Name): NEKEYSHA SANDERS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 BRIDLEWOOD DR
STILLWATER OK
74074-2389
US

IV. Provider business mailing address

2306 BRIDLEWOOD DR
STILLWATER OK
74074-2389
US

V. Phone/Fax

Practice location:
  • Phone: 405-614-4409
  • Fax:
Mailing address:
  • Phone: 405-614-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-310969
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: