Provider Demographics
NPI:1164237525
Name:WATTERS, LAVENA LOVETTE
Entity type:Individual
Prefix:
First Name:LAVENA
Middle Name:LOVETTE
Last Name:WATTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAVENA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24757 E 869 RD
Mailing Address - Street 2:
Mailing Address - City:WELLING
Mailing Address - State:OK
Mailing Address - Zip Code:74471
Mailing Address - Country:US
Mailing Address - Phone:405-778-0553
Mailing Address - Fax:
Practice Address - Street 1:24757 E 869 RD
Practice Address - Street 2:
Practice Address - City:WELLING
Practice Address - State:OK
Practice Address - Zip Code:74471
Practice Address - Country:US
Practice Address - Phone:405-778-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist