Healthcare Provider Details

I. General information

NPI: 1013835586
Provider Name (Legal Business Name): DESTINIE MARIE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 SE 7TH ST
VANCOUVER WA
98683-6909
US

IV. Provider business mailing address

16251 WASHOUGAL RIVER RD
WASHOUGAL WA
98671-7119
US

V. Phone/Fax

Practice location:
  • Phone: 360-699-2244
  • Fax:
Mailing address:
  • Phone: 360-931-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: