Provider Demographics
NPI:1215535323
Name:KINCADE-ANEKI, KERRY JOVITA
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:JOVITA
Last Name:KINCADE-ANEKI
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 1:602 SW A AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3930
Mailing Address - Country:US
Mailing Address - Phone:580-713-8107
Mailing Address - Fax:
Practice Address - Street 1:602 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3930
Practice Address - Country:US
Practice Address - Phone:580-713-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator