Healthcare Provider Details

I. General information

NPI: 1831982560
Provider Name (Legal Business Name): QUARNISHA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 E COUNTY LINE RD APT L96
JACKSON MS
39211-1811
US

IV. Provider business mailing address

1810 SAINT CHARLES ST
JACKSON MS
39209-5407
US

V. Phone/Fax

Practice location:
  • Phone: 769-895-3890
  • Fax:
Mailing address:
  • Phone: 769-895-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: