Healthcare Provider Details

I. General information

NPI: 1023912235
Provider Name (Legal Business Name): SELENA TROTTER WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BELK BLVD
OXFORD MS
38655-5242
US

IV. Provider business mailing address

52 PUTT DR
GRENADA MS
38901-5564
US

V. Phone/Fax

Practice location:
  • Phone: 662-636-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number914834
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: