Provider Demographics
NPI:1184140659
Name:WALTON, AMY LAUREN (CLC, CD(DONA))
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LAUREN
Last Name:WALTON
Suffix:
Gender:F
Credentials:CLC, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 S HARVARD AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4677
Mailing Address - Country:US
Mailing Address - Phone:918-550-1938
Mailing Address - Fax:
Practice Address - Street 1:3939 S HARVARD AVE STE 235
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4677
Practice Address - Country:US
Practice Address - Phone:918-550-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN174H00000X
OK374J00000X
OKALPP-237149174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula