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General NPI Number Information
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NPI Number | 1316556087
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Entity Type | Individual
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Provider Name | KATIE JACKSON WALKER DPT
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Gender | Female
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 27190 HIGHWAY 28
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City | HAZLEHURST
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State | MS
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Zip | 39083-2224
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Country | US
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Telephone | 601-574-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 18068 HIGHWAY 51
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City | HAZLEHURST
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State | MS
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Zip | 39083-9600
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Country | US
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Telephone | 601-506-5704
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5383
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License Number State | MS
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