MEDICARE: JAITAVIA N 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1902507767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAITAVIA N WALKER

Provider Business Mailing Address
First Line	:	707 RED COAT DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-2260
Country	:	US
Telephone Number	:	254-340-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 RED COAT DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-2260
Country	:	US
Telephone Number	:	254-340-9838
Fax Number	:

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

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	03/16/2023

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Directions to “ JAITAVIA N WALKER ” Practice Location

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