Provider Demographics
NPI:1407030620
Name:WALKER, DANA WICKER (DPH)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:WICKER
Last Name:WALKER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1224
Mailing Address - Country:US
Mailing Address - Phone:423-753-4446
Mailing Address - Fax:423-753-4587
Practice Address - Street 1:102 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1224
Practice Address - Country:US
Practice Address - Phone:423-753-4446
Practice Address - Fax:423-753-4587
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist