Provider Demographics
NPI:1134554017
Name:WALKER, AMY LYNN (PRSS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-3154
Mailing Address - Country:US
Mailing Address - Phone:580-247-8830
Mailing Address - Fax:580-622-6137
Practice Address - Street 1:1718 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4244
Practice Address - Country:US
Practice Address - Phone:580-622-6127
Practice Address - Fax:580-622-6137
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator