Healthcare Provider Details

I. General information

NPI: 1962559690
Provider Name (Legal Business Name): GAIL RUSK WALKER L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GAIL LYNN WALKER L.P.C.

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HIGHWAY 80 W SUITE N
CLINTON MS
39056-4108
US

IV. Provider business mailing address

604 HIGHWAY 80 W SUITE N
CLINTON MS
39056
US

V. Phone/Fax

Practice location:
  • Phone: 601-201-5593
  • Fax: 601-925-1722
Mailing address:
  • Phone: 601-201-5593
  • Fax: 601-925-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0586
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: