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1336713213 NPI number — RANDEE KATHRYN WALCK-COETZEE MD

NPI Number: 1336713213
Health Care Provider/Practitioner: RANDEE KATHRYN WALCK-COETZEE MD

Information about “1336713213” NPI (RANDEE KATHRYN WALCK-COETZEE MD) exists in 1336713213 in HTML format HTML  |  1336713213 in plain Text format TXT  |  1336713213 in PDF (Portable Document Format) PDF  |  1336713213 in an XML format XML  formats.

NPI Number : 1336713213 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336713213",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALCK-COETZEE",
    "FirstName": "RANDEE",
    "MiddleName": "KATHRYN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WALCK",
    "OtherFirstName": "RANDEE",
    "OtherMiddleName": "KATHRYN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "15409 SE 49TH ST.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHOCTAUW",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "73020",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "405-618-7793",
    "MailingAddressFaxNumber": "405-272-6985",
    "FirstLinePracticeLocationAddress": "2401 W. WRANGLER BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SEMINOLE",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "74868",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "405-382-3650",
    "PracticeLocationAddressFaxNumber": "405-382-9848",
    "EnumerationDate": "05/17/2021",
    "LastUpdateDate": "02/05/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "38438",
          "LicenseNumberStateCode": "OK",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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