MEDICARE: TYANDRE KAYVAUGHN NEELEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		OK

General Provider Information

NPI Number	:	1477408870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYANDRE KAYVAUGHN NEELEY

Provider Business Mailing Address
First Line	:	2641 LAKERIDGE CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 36TH AVE NW UNIT 100
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-3251
Country	:	US
Telephone Number	:	405-215-9221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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