Provider Demographics
NPI:1639953110
Name:WALKER, JESSE H (MA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:H
Last Name:WALKER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W GRAY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4166
Mailing Address - Country:US
Mailing Address - Phone:803-673-4928
Mailing Address - Fax:
Practice Address - Street 1:1211 W GRAY ST APT 4
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4166
Practice Address - Country:US
Practice Address - Phone:803-673-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program