Provider Demographics
NPI:1679838015
Name:PRIDE, NEKIA SHAWNTELLE
Entity type:Individual
Prefix:MS
First Name:NEKIA
Middle Name:SHAWNTELLE
Last Name:PRIDE
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:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:LANGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73050-0106
Mailing Address - Country:US
Mailing Address - Phone:918-840-9585
Mailing Address - Fax:
Practice Address - Street 1:209 SW LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LANGSTON
Practice Address - State:OK
Practice Address - Zip Code:73050
Practice Address - Country:US
Practice Address - Phone:918-840-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional