Provider Demographics
NPI:1598178089
Name:WALKER, JENNIFER (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:WV
Mailing Address - Zip Code:26260-0631
Mailing Address - Country:US
Mailing Address - Phone:304-516-7251
Mailing Address - Fax:
Practice Address - Street 1:122 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:WV
Practice Address - Zip Code:26292-0122
Practice Address - Country:US
Practice Address - Phone:304-516-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV96213171100000X
MDU01959171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist