Healthcare Provider Details

I. General information

NPI: 1780458760
Provider Name (Legal Business Name): LESLIE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 4TH AVE
SOUTH CHARLESTON WV
25303-1266
US

IV. Provider business mailing address

325 4TH AVE
SOUTH CHARLESTON WV
25303-1266
US

V. Phone/Fax

Practice location:
  • Phone: 304-744-4940
  • Fax:
Mailing address:
  • Phone: 304-744-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: