Provider Demographics
NPI:1750875290
Name:THOMAS, KEZIYA YASMENE
Entity type:Individual
Prefix:
First Name:KEZIYA
Middle Name:YASMENE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KEZIYA
Other - Middle Name:YASMENE
Other - Last Name:APODOCA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:721 W TEEL RD
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6255
Mailing Address - Country:US
Mailing Address - Phone:918-852-9621
Mailing Address - Fax:
Practice Address - Street 1:102 N DENVER AVE STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-1808
Practice Address - Country:US
Practice Address - Phone:918-582-1200
Practice Address - Fax:918-581-0777
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator