=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336116193
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA HUTT WALKER D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2006
-----------------------------------------------------
Last Update Date | 11/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6263 POPLAR AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38119-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-761-6157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 381587
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38183-1587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-761-6157
-----------------------------------------------------
Fax | 901-761-4145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | DO1320
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------