Healthcare Provider Details

I. General information

NPI: 1841279775
Provider Name (Legal Business Name): TERESA BETH WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NE INDEPENDENCE AVE
LEES SUMMIT MO
64086-5544
US

IV. Provider business mailing address

901 NE INDEPENDENCE AVE
LEES SUMMIT MO
64086-5544
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-8000
  • Fax: 816-246-8207
Mailing address:
  • Phone: 816-246-8000
  • Fax: 816-246-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0428825
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number100306
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: