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Individual

MS. STACY LEA WALKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD, LD

Contact information

Practice address
1334 N LANSING AVE, TULSA, OK 74106-5907
(918) 587-2171
(918) 295-6194
Mailing address
1334 N LANSING AVE, TULSA, OK 74106-5907
(918) 587-2171
(918) 295-6194

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
997106
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1653
OKLA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION
OK
01
997106
AMERICAN DIETETIC ASSOCIATION
OK
Enumeration date
03/30/2010
Last updated
07/30/2012
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