Provider Demographics
NPI:1003547779
Name:GOULD, LAKENDRA JANELL
Entity Type:Individual
Prefix:
First Name:LAKENDRA
Middle Name:JANELL
Last Name:GOULD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4747
Mailing Address - Country:US
Mailing Address - Phone:405-422-7476
Mailing Address - Fax:405-422-8218
Practice Address - Street 1:300 E ELM ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4747
Practice Address - Country:US
Practice Address - Phone:405-422-7476
Practice Address - Fax:405-422-8218
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist