MEDICARE: AWNDREA WALKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	443462	TX
2	164W00000X	Licensed Practical Nurse	314011	TX

General Provider Information

NPI Number	:	1114463650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AWNDREA WALKER

Provider Business Mailing Address
First Line	:	1121 KIELDER CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4514
Country	:	US
Telephone Number	:	817-877-7466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 KIELDER CIR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-4514
Country	:	US
Telephone Number	:	817-877-7466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	01/09/2017

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Directions to “ AWNDREA WALKER ” Practice Location

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