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NPI Code Detail

MEDICARE: KELLY MARIE WALKER

MEDICARE: KELLY MARIE WALKER
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1972980506
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MARIE WALKER
Provider Business Mailing Address
First Line : 800 N WATTERS RD STE 120
Second Line :
City : ALLEN
State : TX
Zip : 75013-5346
Country : US
Telephone Number : 228-234-6760
Fax Number :
Provider Business Practice Location Address
First Line : 800 N WATTERS RD STE 120
Second Line :
City : ALLEN
State : TX
Zip : 75013-5346
Country : US
Telephone Number : 228-234-6760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2015
Last Update Date : 01/03/2024

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