Provider Demographics
NPI:1104215524
Name:RIVERS-LEADER, KAMEYCE JAVELL
Entity Type:Individual
Prefix:
First Name:KAMEYCE
Middle Name:JAVELL
Last Name:RIVERS-LEADER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KAMEYCE
Other - Middle Name:JAVELL
Other - Last Name:RIVERS- LEADER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2625 SW H AVE
Mailing Address - Street 2:APT B
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8129
Mailing Address - Country:US
Mailing Address - Phone:580-647-4640
Mailing Address - Fax:
Practice Address - Street 1:2625 SW H AVE
Practice Address - Street 2:APT B
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8129
Practice Address - Country:US
Practice Address - Phone:580-647-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator