Healthcare Provider Details

I. General information

NPI: 1487882700
Provider Name (Legal Business Name): AMY R WALKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S MAIN ST
CALDWELL KS
67022-1531
US

IV. Provider business mailing address

188 NE 20 RD
ANTHONY KS
67003-9035
US

V. Phone/Fax

Practice location:
  • Phone: 620-845-6417
  • Fax:
Mailing address:
  • Phone: 620-842-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60644
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: