Healthcare Provider Details

I. General information

NPI: 1124428628
Provider Name (Legal Business Name): SARAH SPENCER WALKER BC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TCHULA ST
LEXINGTON MS
39095-3111
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 662-834-1855
  • Fax: 662-834-4953
Mailing address:
  • Phone:
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR882289
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: