Healthcare Provider Details

I. General information

NPI: 1104066380
Provider Name (Legal Business Name): WALKER SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 BIG OAK DR
ADKINS TX
78101-2753
US

IV. Provider business mailing address

PO BOX 1198
LA VERNIA TX
78121-1198
US

V. Phone/Fax

Practice location:
  • Phone: 210-264-1728
  • Fax:
Mailing address:
  • Phone: 210-264-1728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DELINA KATHERINE WALKER
Title or Position: LICENSED SURGICAL ASSISTANT
Credential: LSA
Phone: 210-264-1728