Provider Demographics
NPI:1306889878
Name:WALKER, SALLIE J (MS, RN, ARNP)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-752-3162
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:921 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1837
Practice Address - Country:US
Practice Address - Phone:580-223-5311
Practice Address - Fax:580-223-8227
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0030962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP17991Medicare UPIN
OK242704308Medicare PIN