Healthcare Provider Details

I. General information

NPI: 1972720977
Provider Name (Legal Business Name): GERALD A WALKER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ROCKWOOD LN
HAZARD KY
41701-9415
US

IV. Provider business mailing address

115 ROCKWOOD LN
HAZARD KY
41701-9415
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-5761
  • Fax: 606-436-5797
Mailing address:
  • Phone: 606-436-5761
  • Fax: 606-436-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number129505
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: