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General NPI Number Information
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NPI Number | 1235912882
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Entity Type | Individual
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Provider Name | AUSTIN TYLER WALKER RN
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Gender | Male
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 119 DEANNA DR
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City | GUNTOWN
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State | MS
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Zip | 38849-6009
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Country | US
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Telephone | 662-316-2009
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Fax |
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Provider Business Mailing Address
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Address Line | 3093 BROADWAY UNIT 380
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City | OAKLAND
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State | CA
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Zip | 94611-5787
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Country | US
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Telephone | 662-316-2009
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 897107
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License Number State | MS
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