Healthcare Provider Details

I. General information

NPI: 1992173454
Provider Name (Legal Business Name): WALTER DELONG APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 507
TULSA OK
74136-7807
US

IV. Provider business mailing address

6465 S YALE AVE STE 507
TULSA OK
74136-7807
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-5000
  • Fax:
Mailing address:
  • Phone: 918-712-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN 00150454
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number210113
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: