Healthcare Provider Details

I. General information

NPI: 1740615814
Provider Name (Legal Business Name): DANIEL M WALKER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S FOURTH ST
MORTON MS
39117-3407
US

IV. Provider business mailing address

347 S FOURTH ST
MORTON MS
39117-3407
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-1524
  • Fax:
Mailing address:
  • Phone: 601-732-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0813161
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: