Provider Demographics
NPI:1518214857
Name:WALKER, JEDIDIAH DAVID (BS)
Entity Type:Individual
Prefix:MR
First Name:JEDIDIAH
Middle Name:DAVID
Last Name:WALKER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211 N COUNCIL RD APT 736
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-1344
Mailing Address - Country:US
Mailing Address - Phone:405-613-8060
Mailing Address - Fax:
Practice Address - Street 1:7905 E US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9225
Practice Address - Country:US
Practice Address - Phone:405-613-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator