Provider Demographics
NPI:1043523368
Name:BLANEY, WALKER STEPHEN
Entity Type:Individual
Prefix:MR
First Name:WALKER
Middle Name:STEPHEN
Last Name:BLANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CROW MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-7818
Mailing Address - Country:US
Mailing Address - Phone:479-886-1633
Mailing Address - Fax:
Practice Address - Street 1:3824 N MERIDIAN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2853
Practice Address - Country:US
Practice Address - Phone:405-602-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator