Provider Demographics
NPI:1922096742
Name:WALKUP, STEVE C (PA)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:C
Last Name:WALKUP
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 N MERIDIAN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8316
Mailing Address - Country:US
Mailing Address - Phone:405-755-4290
Mailing Address - Fax:405-755-7773
Practice Address - Street 1:13313 N MERIDIAN AVE STE D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8316
Practice Address - Country:US
Practice Address - Phone:405-755-4290
Practice Address - Fax:405-755-7773
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK749363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100718840BMedicaid
OK24H616515Medicare PIN
OKOKA102042Medicare PIN
S01067Medicare UPIN
OKOKA100678Medicare PIN
OK244501502Medicare ID - Type Unspecified