Healthcare Provider Details

I. General information

NPI: 1790426104
Provider Name (Legal Business Name): ANNASTASHIA WALKER BHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MEDICAL PKWY
CLAREMORE OK
74017-1088
US

IV. Provider business mailing address

607 SW BOULEVARD
INOLA OK
74036-7001
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-8080
  • Fax:
Mailing address:
  • Phone: 970-313-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: