Provider Demographics
NPI:1649530874
Name:NEEQUAYE, LAKEDRICK PAPA NII
Entity type:Individual
Prefix:MR
First Name:LAKEDRICK
Middle Name:PAPA NII
Last Name:NEEQUAYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 NW 23RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2645
Mailing Address - Country:US
Mailing Address - Phone:405-917-1709
Mailing Address - Fax:
Practice Address - Street 1:4209 NW 23RD ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2645
Practice Address - Country:US
Practice Address - Phone:405-917-1709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK352409511Medicaid