MEDICARE: CAROLYN T WALTERS ARNP

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	363LW0102X	Women's Health Nurse Practitioner	R0022683	OK

General Provider Information

NPI Number	:	1861438293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN T WALTERS ARNP

Provider Business Mailing Address
First Line	:	4617 S FLORENCE PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-5217
Country	:	US
Telephone Number	:	918-743-4347
Fax Number	:

Provider Business Practice Location Address
First Line	:	4870 S LEWIS AVE
Second Line	:	SUITE 130
City	:	TULSA
State	:	OK
Zip	:	74105-5151
Country	:	US
Telephone Number	:	918-398-6810
Fax Number	:	918-398-6811

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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