1972645836 NPI number — MRS. JOANNE R WALKUP PT

Table of content: MRS. JOANNE R WALKUP PT (NPI 1972645836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972645836 NPI number — MRS. JOANNE R WALKUP PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKUP
Provider First Name:
JOANNE
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972645836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6804 OLD ORCHARD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73132-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-722-9736
Provider Business Mailing Address Fax Number:
405-722-9736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1024 NW 47TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73118-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-650-9405
Provider Business Practice Location Address Fax Number:
405-606-2008
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  1204 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100645000D . This is a "MEDICAID DME" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100645000A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1972645836 . This is a "HEALTH CHOICE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1972645836 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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