Provider Demographics
NPI:1114928975
Name:WALKER, DAVID L (APRN - CNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:WALKER
Suffix:
Gender:M
Credentials:APRN - CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8773 W 103RD ST S
Mailing Address - Street 2:
Mailing Address - City:OKTAHA
Mailing Address - State:OK
Mailing Address - Zip Code:74450-2201
Mailing Address - Country:US
Mailing Address - Phone:918-441-5676
Mailing Address - Fax:918-684-9904
Practice Address - Street 1:8773 W 103ST S
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:918-441-5676
Practice Address - Fax:918-684-9904
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0050751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P43779Medicare UPIN