Healthcare Provider Details

I. General information

NPI: 1194514380
Provider Name (Legal Business Name): KRYSTAL DANIELLE WALKER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W MAIN ST
EL CENTRO CA
92243-3040
US

IV. Provider business mailing address

385 W MAIN ST
EL CENTRO CA
92243-3040
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-5000
  • Fax: 760-337-5400
Mailing address:
  • Phone: 760-482-5000
  • Fax: 760-337-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: