Healthcare Provider Details

I. General information

NPI: 1760015721
Provider Name (Legal Business Name): DENNIS G WALKER FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N AVENUE F
CROWLEY LA
70526-5044
US

IV. Provider business mailing address

421 N AVENUE F
CROWLEY LA
70526-5044
US

V. Phone/Fax

Practice location:
  • Phone: 337-514-5065
  • Fax: 844-392-7926
Mailing address:
  • Phone: 337-514-5065
  • Fax: 844-392-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ERIN ACHANE
Title or Position: OWNER
Credential: CPC
Phone: 337-514-5065