Provider Demographics
NPI:1619983681
Name:WALKER, CRYSTAL RACHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:RACHELLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6943 W 37TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-9302
Mailing Address - Country:US
Mailing Address - Phone:316-613-2077
Mailing Address - Fax:316-613-2969
Practice Address - Street 1:6943 W 37TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9302
Practice Address - Country:US
Practice Address - Phone:316-613-2077
Practice Address - Fax:316-613-2969
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200385980 AMedicaid