Healthcare Provider Details

I. General information

NPI: 1184234130
Provider Name (Legal Business Name): BROOKE ANN WALLING APRN-CNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W TECUMSEH RD STE 106
NORMAN OK
73072-1810
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-0044
  • Fax: 405-307-5621
Mailing address:
  • Phone: 405-307-6668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number99998
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: