MEDICARE: TIFFANIE DAWN WALKER MA

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	103TC0700X	Clinical Psychologist	2311	NC
2	103T00000X	Psychologist	2311	NC

General Provider Information

NPI Number	:	1194982439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANIE DAWN WALKER MA

Provider Business Mailing Address
First Line	:	284 EXECUTIVE PARK DR
Second Line	:	SUITE 100
City	:	CONCORD
State	:	NC
Zip	:	28025-1831
Country	:	US
Telephone Number	:	704-939-1100
Fax Number	:	704-939-1173

Provider Business Practice Location Address
First Line	:	943 W ANDREWS AVE
Second Line	:	SUITE H
City	:	HENDERSON
State	:	NC
Zip	:	27536-2516
Country	:	US
Telephone Number	:	252-433-0061
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	01/21/2021

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