Provider Demographics
NPI:1033870175
Name:WILLIAMS, TAMARA KAYE
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:KAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:KAYE
Other - Last Name:CLEMENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5221 ROYAL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-5065
Mailing Address - Country:US
Mailing Address - Phone:405-900-1583
Mailing Address - Fax:
Practice Address - Street 1:1200 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1022
Practice Address - Country:US
Practice Address - Phone:405-248-9361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator