Provider Demographics
NPI:1124726435
Name:RIDGEWAY-WALTON, ALYSIA DAWN
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:DAWN
Last Name:RIDGEWAY-WALTON
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 1:817 MABEL C FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2811
Mailing Address - Country:US
Mailing Address - Phone:405-764-4364
Mailing Address - Fax:
Practice Address - Street 1:817 MABEL C FRY BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2811
Practice Address - Country:US
Practice Address - Phone:405-764-4364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider