Healthcare Provider Details

I. General information

NPI: 1861484933
Provider Name (Legal Business Name): JOAN WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 BREAZEALE SPRINGS ST
NATCHITOCHES LA
71457-4278
US

IV. Provider business mailing address

105 JEFFERSON ST
NATCHITOCHES LA
71457-4350
US

V. Phone/Fax

Practice location:
  • Phone: 318-357-2056
  • Fax: 318-521-8031
Mailing address:
  • Phone: 318-357-2086
  • Fax: 318-521-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025544
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: