Healthcare Provider Details

I. General information

NPI: 1568112019
Provider Name (Legal Business Name): JANIECE IRA WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 41 BOX 15
APO AE
09461-9001
US

IV. Provider business mailing address

48TH MDG RAF LAKENHEATH. UNIT 5210, BOX 230
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024012128
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: