Provider Demographics
NPI:1700036415
Name:WALKER, ANDRE (QBHP)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 N RODNEY PARHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1685
Mailing Address - Country:US
Mailing Address - Phone:501-389-8100
Mailing Address - Fax:870-534-5406
Practice Address - Street 1:9101 N RODNEY PARHAM RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1685
Practice Address - Country:US
Practice Address - Phone:501-389-8100
Practice Address - Fax:888-977-2956
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1700036415Medicaid