Provider Demographics
NPI:1760187686
Name:WALKER, DORTHY GRACE (CHA)
Entity Type:Individual
Prefix:
First Name:DORTHY
Middle Name:GRACE
Last Name:WALKER
Suffix:
Gender:F
Credentials:CHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:CLARKS POINT
Mailing Address - State:AK
Mailing Address - Zip Code:99569-0049
Mailing Address - Country:US
Mailing Address - Phone:907-236-1232
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKS POINT
Practice Address - State:AK
Practice Address - Zip Code:99569-9800
Practice Address - Country:US
Practice Address - Phone:907-236-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23-1703-I172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker