Individual
MRS. NIKISHI MICHE WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T
Contact information
Practice address
17110 E 51ST ST, BROKEN ARROW, OK 74012-9279
(918) 355-0758
Mailing address
2608 W MONTGOMERY ST, BROKEN ARROW, OK 74012-7445
(918) 798-5954
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3130
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030523284007
EXISTING BCBSOK PROVIDER#
OK
Enumeration date
01/05/2007
Last updated
07/08/2007
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