Healthcare Provider Details

I. General information

NPI: 1316983620
Provider Name (Legal Business Name): ROSALYN C WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 E WOODROW WILSON AVE
JACKSON MS
39216-4538
US

IV. Provider business mailing address

570 E WOODROW WILSON AVE
JACKSON MS
39216-4538
US

V. Phone/Fax

Practice location:
  • Phone: 601-576-7472
  • Fax: 601-576-7825
Mailing address:
  • Phone: 601-576-7472
  • Fax: 601-576-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number11433
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: