Active NPI
Retonya J Walters
- Contractor
- Muskogee, OK
National Provider Identifier
1699804419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 5459050001
- Practice address
- 2901 W Broadway St
Muskogee, OK 74401-2718 - Phone
- (918) 683-5828
- Fax
- (918) 683-5828
- NPI assigned
- Mar 5, 2007
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 5459050001 | OK | Primary |
Addresses
Primary practice location
2901 W Broadway St
Muskogee, OK 74401-2718
Mailing address
2901 W Broadway St
Muskogee, OK 74401-2718
Phone (918) 683-5828
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5459050001 | OK | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198713600000",
"number": "1699804419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 W BROADWAY ST",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744012718",
"telephone_number": "918-683-5828",
"fax_number": "918-683-5828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 W BROADWAY ST",
"city": "MUSKOGEE",
"state": "OK",
"postal_code": "744012718",
"telephone_number": "918-683-5828",
"fax_number": "918-683-5828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "RETONYA",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2007-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "OK",
"license": "5459050001",
"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 Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.