Provider Demographics
NPI:1356684294
Name:DOAKES, TAYELAR S (CM I)
Entity Type:Individual
Prefix:
First Name:TAYELAR
Middle Name:S
Last Name:DOAKES
Suffix:
Gender:F
Credentials:CM I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6835
Mailing Address - Country:US
Mailing Address - Phone:405-605-0398
Mailing Address - Fax:405-605-2278
Practice Address - Street 1:1330 N CLASSEN BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6835
Practice Address - Country:US
Practice Address - Phone:405-605-0398
Practice Address - Fax:405-605-2278
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK183700000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No183700000XPharmacy Service ProvidersPharmacy Technician