Healthcare Provider Details

I. General information

NPI: 1801050414
Provider Name (Legal Business Name): DELINA KATHERINE WALKER LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2008
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: 830-217-5016
  • 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 NumberSA00578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: