| Organization Name: | JERAMIAH WALKER APRN CNP PLLC |
| NPI Number: | 1053732784 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERAMIAH WALKER (OWNER) |
| Mailing Address: | 300 Nw 32nd St Newcastle |
| State: | OK US |
| Postal Code: | 730656300 |
| Phone Number: | 4053873838 |
| Fax Number: | 4053873822 |
| NPI Enumeration Date: | 12/24/2013 |
| NPI Last Update Date: | 12/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R0073208 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |