Healthcare Provider Details

I. General information

NPI: 1003239088
Provider Name (Legal Business Name): DR. EDWIN WALKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 07/21/2022
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8369 FLORIDA BLVD SUITE 1
DENHAM SPRINGS LA
70726-7862
US

IV. Provider business mailing address

8369 FLORIDA BLVD SUITE 8
DENHAM SPRINGS LA
70726-7862
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-5149
  • Fax: 225-667-1770
Mailing address:
  • Phone: 225-665-5149
  • Fax: 225-667-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN HEBERT BUSBY BIBLE
Title or Position: ADMINISTRATOR
Credential: LPN, CA
Phone: 225-665-5149