Provider Demographics
NPI:1699165936
Name:RAY, LAVETRA
Entity type:Individual
Prefix:
First Name:LAVETRA
Middle Name:
Last Name:RAY
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 1:2601 N KENTUCKY
Mailing Address - Street 2:APT 423
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-1282
Mailing Address - Country:US
Mailing Address - Phone:816-394-8878
Mailing Address - Fax:
Practice Address - Street 1:2601 N KENTUCKY
Practice Address - Street 2:APT 423
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1282
Practice Address - Country:US
Practice Address - Phone:816-394-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator