Provider Demographics
NPI:1336713213
Name:WALCK-COETZEE, RANDEE KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:RANDEE
Middle Name:KATHRYN
Last Name:WALCK-COETZEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RANDEE
Other - Middle Name:KATHRYN
Other - Last Name:WALCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15409 SE 49TH ST.
Mailing Address - Street 2:
Mailing Address - City:CHOCTAUW
Mailing Address - State:OK
Mailing Address - Zip Code:73020
Mailing Address - Country:US
Mailing Address - Phone:405-618-7793
Mailing Address - Fax:405-272-6985
Practice Address - Street 1:2401 W. WRANGLER BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868
Practice Address - Country:US
Practice Address - Phone:405-382-3650
Practice Address - Fax:405-382-9848
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK38438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program