Healthcare Provider Details

I. General information

NPI: 1881348084
Provider Name (Legal Business Name): ANNIE BETTIS WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 AIRPORT BLVD
MOBILE AL
36608-3785
US

IV. Provider business mailing address

122 JAY CIR
JACKSON AL
36545-2450
US

V. Phone/Fax

Practice location:
  • Phone: 904-372-3943
  • Fax: 904-212-1618
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-119144
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: