Provider Demographics
NPI:1144883430
Name:BLAKEMORE, CHEKOTA LEEANN (BA)
Entity type:Individual
Prefix:MRS
First Name:CHEKOTA
Middle Name:LEEANN
Last Name:BLAKEMORE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:CHEKOTA
Other - Middle Name:LEEANN
Other - Last Name:MEDLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:701 S RENNIE ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-7851
Mailing Address - Country:US
Mailing Address - Phone:580-665-7888
Mailing Address - Fax:
Practice Address - Street 1:701 S RENNIE ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-7851
Practice Address - Country:US
Practice Address - Phone:580-665-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator