MEDICARE: KATY LEIGH WALLACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1518410695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY LEIGH WALLACE

Provider Business Mailing Address
First Line	:	113 W SHAWNEE ST
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-3623
Country	:	US
Telephone Number	:	918-825-1405
Fax Number	:	918-825-1406

Provider Business Practice Location Address
First Line	:	113 W SHAWNEE ST
Second Line	:
City	:	TAHLEQUAH
State	:	OK
Zip	:	74464-3623
Country	:	US
Telephone Number	:	918-825-1405
Fax Number	:	918-825-1406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	08/01/2016

Similar Medicare Providers

1083919179 — TERESA WILIE KENNISON MS, LPC
Practice Location Address:

113 W SHAWNEE ST
TAHLEQUAH, OK
74464-3623

Practice Phone: 580-579-3620
Practice Fax:

1326406109 — KARRI LOCUST
Practice Location Address:

113 W SHAWNEE ST
TAHLEQUAH, OK
74464-3623

Practice Phone: 918-825-1405
Practice Fax: 918-825-1406

1982864054 — JAMEEL AMEER UQDAH M.D.
Practice Location Address:

1500 E DOWNING ST STE 101
TAHLEQUAH, OK
74464-3354

Practice Phone: 918-434-7440
Practice Fax:

1194438473 — WRAP INC
Practice Location Address:

113 W KEETOOWAH ST
TAHLEQUAH, OK
74464-3819

Practice Phone: 918-931-3700
Practice Fax:

1710664842 — BOBBY LEE HAYES
Practice Location Address:

113 W KEETOOWAH ST
TAHLEQUAH, OK
74464-3819

Practice Phone: 918-931-3700
Practice Fax:

1952269300 — ASHLEY FLUTE
Practice Location Address:

1101 E CRAFTON PL APT 6
TAHLEQUAH, OK
74464-5902

Practice Phone: 918-570-6051
Practice Fax:

Directions to “ KATY LEIGH WALLACE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.