Provider Demographics
NPI:1861064578
Name:BOST, TAMARA RAYCHELLE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:RAYCHELLE
Last Name:BOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:RAYCHELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:BOLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74829-0218
Mailing Address - Country:US
Mailing Address - Phone:918-667-3367
Mailing Address - Fax:
Practice Address - Street 1:369026 US HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:BOLEY
Practice Address - State:OK
Practice Address - Zip Code:74829-3003
Practice Address - Country:US
Practice Address - Phone:918-667-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator