Provider Demographics
NPI:1205229911
Name:WALKER, FATISHA ANTIONETTE
Entity Type:Individual
Prefix:
First Name:FATISHA
Middle Name:ANTIONETTE
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 1:2302 TIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77093-6731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:832-559-8584
Practice Address - Street 1:2312 TIDWELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-6731
Practice Address - Country:US
Practice Address - Phone:281-272-0888
Practice Address - Fax:832-559-8584
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily