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Individual

DIAN M WALSTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
1510 S VIRGINIA AVE, ATOKA, OK 74525-3246
(580) 889-6621
(580) 889-6659
Mailing address
1510 S VIRGINIA AVE, ATOKA, OK 74525-3246
(580) 889-6621
(580) 889-6659

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1229
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200009950A
OK
Enumeration date
03/11/2006
Last updated
10/29/2009
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