Provider Demographics
NPI:1104045301
Name:WALKER FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:WALKER FAMILY PRACTICE, LLC
Other - Org Name:DAVID WALKER APRN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:918-684-9904
Mailing Address - Street 1:8721 WAINWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:OKTAHA
Mailing Address - State:OK
Mailing Address - Zip Code:74450-4718
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8721 WAINWRIGHT RD
Practice Address - Street 2:
Practice Address - City:OKTAHA
Practice Address - State:OK
Practice Address - Zip Code:74450-4718
Practice Address - Country:US
Practice Address - Phone:918-684-9904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0050751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522533Medicare ID - Type UnspecifiedGROUP #