Individual
KELSEY NICOLE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN - CNP
Contact information
Practice address
1120 S UTICA AVE, TULSA, OK 74104-4012
(918) 579-1000
Mailing address
1265 S UTICA AVE, TULSA, OK 74104-4243
(918) 592-0999
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0116890
OK
363LA2100X
Acute Care Nurse Practitioner
Primary
205116
OK
Other
Enumeration date
06/21/2021
Last updated
09/02/2021
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