Individual
SHELLY D WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
Mailing address
301 CEDAR ST, OROFINO, ID 83544-9029
(208) 476-4555
(208) 476-5385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38491
OK
207Q00000X
Family Medicine Physician
M-15041
ID
207Q00000X
Family Medicine Physician
ML60390210
WA
Other
Enumeration date
08/26/2013
Last updated
07/23/2021
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