Provider Demographics
NPI:1073590824
Name:WALKER, KENNETH B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:B
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:4300 W MEMORIAL RD
Practice Address - Street 2:ER DEPT.
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8304
Practice Address - Country:US
Practice Address - Phone:405-752-3733
Practice Address - Fax:405-749-4561
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200009690AMedicaid
OK200009690AMedicaid
OK24H618621Medicare PIN
OKP90318Medicare UPIN
OK243601001Medicare PIN
OK243536104Medicare PIN