Provider Demographics
NPI:1790808731
Name:WALTERS, KAREN RUTH (RN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RUTH
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14630 COUNTY ROAD 3501
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2754
Mailing Address - Country:US
Mailing Address - Phone:580-436-0683
Mailing Address - Fax:
Practice Address - Street 1:1308 CRADDUCK RD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-8442
Practice Address - Country:US
Practice Address - Phone:580-332-3699
Practice Address - Fax:580-421-9828
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0049232163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management