Active NPI
Sericca Lynn Walters, RD LD
- Registered Dietitian
- Muskogee, OK
National Provider Identifier
1356985287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2476
- Practice address
- 1011 Honor Heights Dr
Muskogee, OK 74401-1318 - Phone
- (918) 351-4752
- NPI assigned
- Nov 4, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2476 | OK | Primary |
Addresses
Primary practice location
1011 Honor Heights Dr
Muskogee, OK 74401-1318
Mailing address
20731 W Haskell Lake Rd
Haskell, OK 74436-5039
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2476 | OK | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1356985287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20731 W HASKELL LAKE RD",
"city": "HASKELL",
"state": "OK",
"postal_code": "744365039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 HONOR HEIGHTS DR",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744011318",
"telephone_number": "918-351-4752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "SERICCA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "RD LD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-04",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "2476",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskogee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.