Provider Demographics
NPI:1407189905
Name:NOLAND, KLESHA LADAWN (BA, CM II,BHRS)
Entity type:Individual
Prefix:
First Name:KLESHA
Middle Name:LADAWN
Last Name:NOLAND
Suffix:
Gender:F
Credentials:BA, CM II,BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 S HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-5958
Mailing Address - Country:US
Mailing Address - Phone:405-858-2935
Mailing Address - Fax:405-272-0472
Practice Address - Street 1:2512 S HARVEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-5958
Practice Address - Country:US
Practice Address - Phone:405-858-2935
Practice Address - Fax:405-272-0472
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100685660AMedicaid
OK100685660DMedicaid