Healthcare Provider Details

I. General information

NPI: 1184140659
Provider Name (Legal Business Name): AMY LAUREN WALTON CLC, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 S HARVARD AVE STE 235
TULSA OK
74135-4677
US

IV. Provider business mailing address

3939 S HARVARD AVE STE 235
TULSA OK
74135-4677
US

V. Phone/Fax

Practice location:
  • Phone: 918-550-1938
  • Fax:
Mailing address:
  • Phone: 918-550-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberALPP-237149
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: