Healthcare Provider Details

I. General information

NPI: 1285226340
Provider Name (Legal Business Name): ANDREA WALKER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W MAIN ST
COLLINSVILLE OK
74021-3114
US

IV. Provider business mailing address

1205 W MAIN ST
COLLINSVILLE OK
74021-3114
US

V. Phone/Fax

Practice location:
  • Phone: 918-387-0440
  • Fax: 918-921-7706
Mailing address:
  • Phone: 918-748-7500
  • Fax: 918-921-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number116016
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number207888
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: