Provider Demographics
NPI:1114540291
Name:WALKER, TELISHA MAYBELLE
Entity Type:Individual
Prefix:
First Name:TELISHA
Middle Name:MAYBELLE
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 1:2002 NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8727
Mailing Address - Country:US
Mailing Address - Phone:352-437-9368
Mailing Address - Fax:
Practice Address - Street 1:2002 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-8727
Practice Address - Country:US
Practice Address - Phone:352-437-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health