Provider Demographics
NPI:1740615814
Name:WALKER, DANIEL M (NP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:WALKER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 S FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:MS
Mailing Address - Zip Code:39117-3407
Mailing Address - Country:US
Mailing Address - Phone:601-732-1524
Mailing Address - Fax:
Practice Address - Street 1:347 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:MS
Practice Address - Zip Code:39117-3407
Practice Address - Country:US
Practice Address - Phone:601-732-1524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF0813161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily