Provider Demographics
NPI:1699359075
Name:WALTON, TAMMY MACHELL
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MACHELL
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 S 120TH EAST PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2850
Mailing Address - Country:US
Mailing Address - Phone:918-237-5220
Mailing Address - Fax:
Practice Address - Street 1:3603 S 120TH EAST PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2850
Practice Address - Country:US
Practice Address - Phone:918-237-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator