Provider Demographics
NPI:1760015721
Name:DENNIS G WALKER FAMILY CLINIC
Entity Type:Organization
Organization Name:DENNIS G WALKER FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHANE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:337-514-5065
Mailing Address - Street 1:421 N AVENUE F
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-5044
Mailing Address - Country:US
Mailing Address - Phone:337-514-5065
Mailing Address - Fax:844-392-7926
Practice Address - Street 1:421 N AVENUE F
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-5044
Practice Address - Country:US
Practice Address - Phone:337-514-5065
Practice Address - Fax:844-392-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA47441Medicaid