KELLY J WALWORTH (NPI# 1376526756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376526756 |
| Entity Type | Individual |
| Full Name | KELLY J WALWORTH |
| Credential | PAC |
| Practice Address |
13174 N Macarthur Blvd Oklahoma City OK 73142-3017 |
| Mailing Address |
Dept 96-0317 Oklahoma City OK 73196-0317 |
| Practice Telephone | 4057215555 |
| Practice Fax Number | 4054707093 |
| Mailing Telephone | (405) 521-1969 |
| Mailing Fax Number | 4055211979 |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2017-08-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
1460 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | GROUP NPI | 1710198569 | 01 |
| OK | 200265130A | 05 |
| Street Address |
13174 N MACARTHUR BLVD |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73142-3017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114909405 | Mark A Dawkins | Dermatology | 13174 N Macarthur Blvd, Oklahoma City, OK 73142-3017 | 2005-11-14 |
| 1760723662 | Alma Jordan Hintze | Physician Assistant | 13174 N Macarthur Blvd, Oklahoma City, OK 73142-3017 | 2013-03-04 |
| 1528200193 | Sunita Chahar Crittenden | Dermatology | 13174 N Macarthur Blvd, Oklahoma City, OK 73142-3017 | 2009-03-29 |
| 1710198569 | Mark A Dawkins Md PC | Dermatology | 13174 N Macarthur Blvd, Oklahoma City, OK 73142-3017 | 2007-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184003790 | Advance Physicians Group LLC | Clinic/Center | 13401 N Macarthur Blvd, Oklahoma City, OK 73142 | 2015-05-28 |
| 1366840084 | Lindsey Jackson | Case Manager/Care Coordinator | 12051 Parkland Pl, Oklahoma City, OK 73142 | 2014-12-11 |
| 1164866737 | Vitality Wellness | Clinic/Center | 5740 Nw 135th St., Oklahoma City, OK 73142 | 2013-04-25 |
| 1356694558 | Joel Mitchell Sprinkle | Community Health Worker | 13100 Brandon Pl, Oklahoma City, OK 73142 | 2012-10-25 |
| 1689923856 | Sampson Mcsidney | Case Management | 14717 Hollyhock Dr, Oklahoma City, OK 73142 | 2012-09-04 |
| 1992087860 | Derek Reed Mccarver | Pharmacist | 1400 E. 2nd St, Edmond, OK 73142 | 2011-09-15 |
| 1326335811 | Laser Spine Surgery Center of Oklahoma, LLC | Clinic/Center | 4727 Gaillardia Parkway, Suite 150, Oklahoma City, OK 73142 | 2011-07-05 |
| 1215220801 | James Kenneth Fisher | Psychologist | 12522 Abbotts Way, Oklahoma City, OK 73142 | 2011-05-16 |
| 1174850408 | Diagnostic Laboratory of Oklahoma, LLC | Clinical Medical Laboratory | 5911 West Memorial Road, Oklahoma City, OK 73142 | 2009-11-06 |
| 1417113275 | Reuben Seth Thomas | Optometrist | 6200 W Memorial Rd Ste A, Oklahoma City, OK 73142 | 2008-07-31 |
| Find all providers in zip 73142 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982172029 | William Landon Ross | Physician Assistant | 3705 W Memorial Rd Ste 101, Oklahoma City, OK 73134-1508 | 2018-11-07 |
| 1639646656 | Jacob Allbritton | Physician Assistant | 10824 Admiral Dr, Oklahoma City, OK 73162-6843 | 2018-10-29 |
| 1073004768 | Shelby Teel | Physician Assistant | 1200 Everett Dr # 8305, Oklahoma City, OK 73104-5047 | 2018-05-29 |
| 1255871349 | Michele Starr | Physician Assistant | 409 Nw 39th St, Oklahoma City, OK 73118-8415 | 2017-03-08 |
| 1972042141 | Nathan Carl Kadavy | Physician Assistant | 440 N Portland Ave, Suite 1000, Oklahoma City, OK 73107-6110 | 2017-02-21 |
| 1487191946 | Neilee Wood | Physician Assistant | 8121 Nw 119th St, Oklahoma City, OK 73162-1110 | 2017-01-23 |
| 1508316530 | Shayniel Stears | Physician Assistant | 16201 Gossamer Way, Oklahoma City, OK 73165-1503 | 2016-10-13 |
| 1386016566 | D'amber Nicole Chambers | Physician Assistant | 1918 Ne 23rd St, Oklahoma City, OK 73111-3328 | 2015-10-27 |
| 1700263928 | Micaela Lupov | Physician Assistant | 101 N Robinson Ave Ste 200, Oklahoma City, OK 73102 | 2015-04-27 |
| 1710380001 | Whitney Ward | Physician Assistant | 4120 W Memorial Rd Ste 300, Oklahoma City, OK 73120-9322 | 2014-10-01 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73142 |
Please comment or provide details below to improve the information on KELLY J WALWORTH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.