Provider Demographics
NPI:1598790172
Name:WALKER, MICHAEL A (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2193 HIGGINBOTHAM HWY
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-5037
Mailing Address - Country:US
Mailing Address - Phone:337-280-8772
Mailing Address - Fax:
Practice Address - Street 1:2193 HIGGINBOTHAM HWY
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-5037
Practice Address - Country:US
Practice Address - Phone:337-280-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA30183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1022217Medicaid
LA5L446P375Medicare ID - Type Unspecified
LA5CN33P989Medicare PIN