Healthcare Provider Details

I. General information

NPI: 1902924251
Provider Name (Legal Business Name): TAMETRA L. COLE-DAVIS BS,BHRS,CM-CAF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W A ST
WATONGA OK
73772-4208
US

IV. Provider business mailing address

502 S NOBLE AVE
WATONGA OK
73772-5208
US

V. Phone/Fax

Practice location:
  • Phone: 580-623-7199
  • Fax: 580-623-7188
Mailing address:
  • Phone: 580-623-7199
  • Fax: 580-623-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10239
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: