MEDICARE: GAYLA WALKER LVN

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	164X00000X	Licensed Vocational Nurse	154808	TX

General Provider Information

NPI Number	:	1770967192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLA WALKER LVN

Provider Business Mailing Address
First Line	:	4804 HAVERWOOD LN
Second Line	:	#211
City	:	DALLAS
State	:	TX
Zip	:	75287-4303
Country	:	US
Telephone Number	:	469-216-2793
Fax Number	:

Provider Business Practice Location Address
First Line	:	4804 HAVERWOOD LN
Second Line	:	#211
City	:	DALLAS
State	:	TX
Zip	:	75287-4303
Country	:	US
Telephone Number	:	469-216-2793
Fax Number	:

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

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	07/15/2015

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