Provider Demographics
NPI:1902924251
Name:COLE-DAVIS, TAMETRA L (BS,BHRS,CM-CAF)
Entity Type:Individual
Prefix:MS
First Name:TAMETRA
Middle Name:L
Last Name:COLE-DAVIS
Suffix:
Gender:F
Credentials:BS,BHRS,CM-CAF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-5208
Mailing Address - Country:US
Mailing Address - Phone:580-623-7199
Mailing Address - Fax:580-623-7188
Practice Address - Street 1:216 W A ST
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-4208
Practice Address - Country:US
Practice Address - Phone:580-623-7199
Practice Address - Fax:580-623-7188
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10239171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator