Provider Demographics
NPI:1841603032
Name:BILLINGSLEY, CAMESHA
Entity Type:Individual
Prefix:
First Name:CAMESHA
Middle Name:
Last Name:BILLINGSLEY
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 1:2816 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-1914
Mailing Address - Country:US
Mailing Address - Phone:405-602-9865
Mailing Address - Fax:
Practice Address - Street 1:2816 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-1914
Practice Address - Country:US
Practice Address - Phone:405-602-9829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKN118819711251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management