Provider Demographics
NPI:1417337080
Name:WALKER, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
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 1:931 HIGHWAY 80 W
Mailing Address - Street 2:2-21B
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3912
Mailing Address - Country:US
Mailing Address - Phone:601-208-0884
Mailing Address - Fax:
Practice Address - Street 1:931 HIGHWAY 80 W
Practice Address - Street 2:2-21B
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3912
Practice Address - Country:US
Practice Address - Phone:601-208-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide