Healthcare Provider Details

I. General information

NPI: 1679436810
Provider Name (Legal Business Name): MRS. AJA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S MAIN ST
HOPE AR
71801-4319
US

IV. Provider business mailing address

225 S MAIN ST
HOPE AR
71801-4319
US

V. Phone/Fax

Practice location:
  • Phone: 870-397-4628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: