Provider Demographics
NPI:1316284862
Name:WALKER, JENNIFER LYNN (PRSS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PRSS
Mailing Address - Street 1:128 SOUTH PETERS
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-701-8163
Mailing Address - Fax:
Practice Address - Street 1:128 SOUTH PETERS
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069
Practice Address - Country:US
Practice Address - Phone:405-701-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK129078171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor