MEDICARE: DORTHY GRACE WALKER CHA

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	172V00000X	Community Health Worker	23-1703-I	AK

General Provider Information

NPI Number	:	1760187686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORTHY GRACE WALKER CHA

Provider Business Mailing Address
First Line	:	PO BOX 49
Second Line	:
City	:	CLARKS POINT
State	:	AK
Zip	:	99569-0049
Country	:	US
Telephone Number	:	907-236-1232
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MAIN ST
Second Line	:
City	:	CLARKS POINT
State	:	AK
Zip	:	99569-9800
Country	:	US
Telephone Number	:	907-236-1232
Fax Number	:

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

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/31/2023

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Directions to “ DORTHY GRACE WALKER CHA” Practice Location

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