Provider Demographics
NPI:1053479931
Name:WALKER, GABRIELLE LASHAY
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:LASHAY
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-0402
Mailing Address - Country:US
Mailing Address - Phone:979-618-1632
Mailing Address - Fax:
Practice Address - Street 1:116 CORRELL AVE
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-5104
Practice Address - Country:US
Practice Address - Phone:979-618-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities