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General NPI Number Information
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NPI Number | 1003317991
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Entity Type | Individual
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Provider Name | ELIZABETH WALRATH NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 3300 CHANDLER RD STE 107
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City | MUSKOGEE
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State | OK
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Zip | 74403-4909
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Country | US
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Telephone | 918-948-6360
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Fax |
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Provider Business Mailing Address
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Address Line | 2745 DALLAS PKWY STE 500
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City | PLANO
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State | TX
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Zip | 75093-8900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP137668
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | M0087916
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 87916
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License Number State | OK
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