Provider Demographics
NPI:1215669189
Name:WALKER, NATAUSHA SHAUNTRECE (FNP-C)
Entity type:Individual
Prefix:
First Name:NATAUSHA
Middle Name:SHAUNTRECE
Last Name:WALKER
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 E LINCOLN RD SUITE B-3
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745
Mailing Address - Country:US
Mailing Address - Phone:903-933-6400
Mailing Address - Fax:580-286-8287
Practice Address - Street 1:805 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3331
Practice Address - Country:US
Practice Address - Phone:580-286-1095
Practice Address - Fax:580-286-3122
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily