Provider Demographics
NPI:1861438293
Name:WALTERS, CAROLYN T (ARNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:T
Last Name:WALTERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 S FLORENCE PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5217
Mailing Address - Country:US
Mailing Address - Phone:918-743-4347
Mailing Address - Fax:
Practice Address - Street 1:4870 S LEWIS AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5151
Practice Address - Country:US
Practice Address - Phone:918-398-6810
Practice Address - Fax:918-398-6811
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0022683363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS88855Medicare UPIN