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General NPI Number Information
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NPI Number | 1811851850
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Entity Type | Individual
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Provider Name | JERCOBY DEMIN WALKER
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Gender | Male
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 606 S 9TH ST
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City | LEESBURG
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State | FL
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Zip | 34748-6320
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Country | US
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Telephone | 352-255-9534
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 ANGEL FISH LOOP
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City | LEESBURG
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State | FL
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Zip | 34748-6162
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Country | US
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Telephone | 352-255-9534
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | W426424022810
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License Number State | FL
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