Healthcare Provider Details

I. General information

NPI: 1164348629
Provider Name (Legal Business Name): KEVINNA MARIE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 JOOR RD STE 300A
BATON ROUGE LA
70818-3925
US

IV. Provider business mailing address

10510 JOOR RD STE 300A
BATON ROUGE LA
70818-3925
US

V. Phone/Fax

Practice location:
  • Phone: 225-960-2403
  • Fax: 225-256-1707
Mailing address:
  • Phone: 225-960-2403
  • Fax: 225-256-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: