Provider Demographics
NPI:1669772224
Name:MESSIMORE, KATHY LEA (BHCM)
Entity type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:LEA
Last Name:MESSIMORE
Suffix:
Gender:F
Credentials:BHCM
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:LEA
Other - Last Name:MESSIMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BHCM
Mailing Address - Street 1:101 S MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5047
Mailing Address - Country:US
Mailing Address - Phone:918-342-6463
Mailing Address - Fax:918-342-6665
Practice Address - Street 1:101 S MOORE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5047
Practice Address - Country:US
Practice Address - Phone:918-342-6463
Practice Address - Fax:918-342-6665
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator