Provider Demographics
NPI:1184234130
Name:WALLING, BROOKE ANN (APRN-CNP, FNP-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:WALLING
Suffix:
Gender:F
Credentials:APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6668
Mailing Address - Fax:
Practice Address - Street 1:3400 W TECUMSEH RD STE 106
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:405-515-0044
Practice Address - Fax:405-307-5621
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily