Provider Demographics
NPI:1053732784
Name:JERAMIAH WALKER APRN CNP PLLC
Entity type:Organization
Organization Name:JERAMIAH WALKER APRN CNP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERAMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-387-3838
Mailing Address - Street 1:PO BOX 20445
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0445
Mailing Address - Country:US
Mailing Address - Phone:405-419-8444
Mailing Address - Fax:405-419-7797
Practice Address - Street 1:300 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6300
Practice Address - Country:US
Practice Address - Phone:405-387-3838
Practice Address - Fax:405-387-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0073208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty