Provider Demographics
NPI:1689973240
Name:WALKUP, AMANDA JEWEL (BS)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JEWEL
Last Name:WALKUP
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 WYNN CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4635
Mailing Address - Country:US
Mailing Address - Phone:405-312-1460
Mailing Address - Fax:
Practice Address - Street 1:3516 WYNN CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4635
Practice Address - Country:US
Practice Address - Phone:405-312-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst