MEDICARE: DR. BRANDI MARIE WALKER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810005960	VA

General Provider Information

NPI Number	:	1326506734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDI MARIE WALKER PHD

Provider Business Mailing Address
First Line	:	40 FALCONRIDGE DR
Second Line	:
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-7192
Country	:	US
Telephone Number	:	703-283-7562
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 REILLY ST BLDG 4-3219
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7324
Country	:	US
Telephone Number	:	910-643-1620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	03/05/2019

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