Healthcare Provider Details

I. General information

NPI: 1366021131
Provider Name (Legal Business Name): JOSHUA K WALLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GREENBRIER BLVD
COVINGTON LA
70433-7233
US

IV. Provider business mailing address

160 GREENBRIER BLVD
COVINGTON LA
70433-7233
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-5780
  • Fax: 985-893-0601
Mailing address:
  • Phone: 985-893-5780
  • Fax: 985-893-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number352107
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number352107
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: