Provider Demographics
NPI:1235795766
Name:WALKER, BETTINA H
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:H
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 1:2170 OAK LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-2370
Mailing Address - Country:US
Mailing Address - Phone:434-222-1554
Mailing Address - Fax:
Practice Address - Street 1:2170 OAK LEVEL RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558-2370
Practice Address - Country:US
Practice Address - Phone:434-222-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide