Healthcare Provider Details

I. General information

NPI: 1043294945
Provider Name (Legal Business Name): HEATHER LINDSAY WALKER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 DIXIE HWY
LOUISVILLE KY
40272-4350
US

IV. Provider business mailing address

10640 DIXIE HWY
LOUISVILLE KY
40272-4350
US

V. Phone/Fax

Practice location:
  • Phone: 502-933-4427
  • Fax:
Mailing address:
  • Phone: 502-933-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7954
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7954
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7954
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: