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General NPI Number Information
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NPI Number | 1235620097
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Entity Type | Individual
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Provider Name | MIRIAM WALKER
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Gender | Female
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Dates
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Enumeration Date | 05/28/2018
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 495 DUNLOP LN STE 112
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City | CLARKSVILLE
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State | TN
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Zip | 37040-5296
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Country | US
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Telephone | 931-221-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 LAMONT CT
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City | CLARKSVILLE
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State | TN
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Zip | 37042-4715
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Country | US
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Telephone | 931-338-7494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS0000011302
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License Number State | TN
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