Healthcare Provider Details

I. General information

NPI: 1255246906
Provider Name (Legal Business Name): TAMMI WALKUP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 ARLINGTON ST
ADA OK
74820-2823
US

IV. Provider business mailing address

21920 COUNTY ROAD 1553
ADA OK
74820-1376
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-2011
  • Fax: 580-332-2011
Mailing address:
  • Phone: 580-332-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: