Provider Demographics
NPI:1326794728
Name:WALKER, FREDERICK WAYNE
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:WAYNE
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 HOPETON DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3297
Mailing Address - Country:US
Mailing Address - Phone:128-168-6661
Mailing Address - Fax:
Practice Address - Street 1:4631 GASTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-1513
Practice Address - Country:US
Practice Address - Phone:281-686-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1234567OtherABCDE