Healthcare Provider Details

I. General information

NPI: 1336713213
Provider Name (Legal Business Name): RANDEE KATHRYN WALCK-COETZEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RANDEE KATHRYN WALCK MD

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 02/05/2025
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W. WRANGLER BLVD
SEMINOLE OK
74868
US

IV. Provider business mailing address

15409 SE 49TH ST.
CHOCTAUW OK
73020
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-3650
  • Fax: 405-382-9848
Mailing address:
  • Phone: 405-618-7793
  • Fax: 405-272-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38438
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: