Healthcare Provider Details

I. General information

NPI: 1235852484
Provider Name (Legal Business Name): DORIS L WALKER-RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10541 EWELL DR
SAINT LOUIS MO
63137-2244
US

IV. Provider business mailing address

10541 EWELL DR
SAINT LOUIS MO
63137-2244
US

V. Phone/Fax

Practice location:
  • Phone: 131-440-9213
  • Fax:
Mailing address:
  • Phone: 131-440-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2000149189
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: