Healthcare Provider Details

I. General information

NPI: 1902446917
Provider Name (Legal Business Name): CHELSEA RYAN WALKER APRN-CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

12455 E 100TH ST N STE 300
OWASSO OK
74055-4678
US

IV. Provider business mailing address

12455 E 100TH ST N STE 300
OWASSO OK
74055-4678
US

V. Phone/Fax

Practice location:
  • Phone: 918-274-9700
  • Fax: 918-274-1395
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number109513
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: