Shelly D Walters, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

38491 Issued in OK

Practice address

1921 Stonecipher Dr
Ada, OK 74820-3439

Phone

(580) 436-3980

NPI assigned

Aug 26, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Shelly D Theobald Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2025 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chickasaw Nation Division of Health

  dba Chickasaw Nation Medical Center

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1255364923
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1386078418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 CEDAR ST",
            "city": "OROFINO",
            "state": "ID",
            "postal_code": "835449029",
            "telephone_number": "208-476-4555",
            "fax_number": "208-476-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748203439",
            "telephone_number": "580-436-3980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Cedar St",
            "address_purpose": "LOCATION",
            "city": "Orofino",
            "state": "ID",
            "postal_code": "835449029",
            "country_code": "US",
            "telephone_number": "082-476-4555",
            "fax_number": "208-476-5385",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "SHELLY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-26",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "ML60390210",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-15041",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "38491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "THEOBALD",
            "middle_name": "D",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lewis Alfred Wallace, DO
• Tonie Waller, DDS
• Kandice Wallis
• Makenzi Ann Walls
• Karen Ruth Walters, RN
• Jonathan Paul Walther, MD
• Connie Leann Walton, RN, LMT
• Larson Dean Walton, BA,AA,AA,AA,AA,AA,AA
• Tarra Ward
• Paul Franklin Warlick, D.O.

• Family Medicine Physician in Ada, OK
• Providers in Ada, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.