Provider Demographics
NPI:1073022653
Name:WALKER CONCIERGE HEALTH AND WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:WALKER CONCIERGE HEALTH AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT GERO NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KIZZY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:469-364-1300
Mailing Address - Street 1:661 E MAIN ST # 200175
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3340
Mailing Address - Country:US
Mailing Address - Phone:469-364-1300
Mailing Address - Fax:
Practice Address - Street 1:661 E MAIN ST # 200175
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3340
Practice Address - Country:US
Practice Address - Phone:469-364-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service