Healthcare Provider Details

I. General information

NPI: 1558305292
Provider Name (Legal Business Name): DIANE M WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 HARRISON AVE
PANAMA CITY FL
32405-4542
US

IV. Provider business mailing address

1940 HARRISON AVE
PANAMA CITY FL
32405-4542
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0017
  • Fax: 850-532-6454
Mailing address:
  • Phone: 850-763-0017
  • Fax: 850-532-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME133042
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12756
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME133042
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number12756
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME133042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: