Provider Demographics
NPI:1093765463
Name:WALKER, LESA CAROL (FNP, APRN)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:CAROL
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 HORIZON RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2058
Mailing Address - Country:US
Mailing Address - Phone:469-402-2800
Mailing Address - Fax:469-402-2848
Practice Address - Street 1:6720 HORIZON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-2058
Practice Address - Country:US
Practice Address - Phone:469-402-2800
Practice Address - Fax:469-402-0348
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569740363LF0000X
TX108002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
27215Medicare UPIN
8G2773Medicare PIN