Healthcare Provider Details

I. General information

NPI: 1831929488
Provider Name (Legal Business Name): TAKIELA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 BRUNSWICK DR APT C
ELYRIA OH
44035-4645
US

IV. Provider business mailing address

259 BRUNSWICK DR APT C
ELYRIA OH
44035-4645
US

V. Phone/Fax

Practice location:
  • Phone: 614-302-2400
  • Fax:
Mailing address:
  • Phone: 614-302-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW.002446
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: