Individual
MAKENZI ANN WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 W 4TH ST, ADA, OK 74820-3411
(580) 436-2690
(580) 436-5539
Mailing address
301 W 4TH ST, ADA, OK 74820-3411
(580) 436-2690
(580) 436-5539
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
130841
OK
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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