Provider Demographics
NPI: | 1760421200 |
---|---|
Name: | WALKER, JAMES RUSSELL (CRNA, DNP) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JAMES |
Middle Name: | RUSSELL |
Last Name: | WALKER |
Suffix: | |
Gender: | M |
Credentials: | CRNA, DNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 9410 SUNDANCE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | PEARLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77584-2892 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1 BAYLOR PLZ |
Practice Address - Street 2: | MS; BCM120 |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77030-3411 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-798-7356 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-06 |
Last Update Date: | 2015-05-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 557196 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 088986701 | Medicaid | |
TX | 88899C | Medicare ID - Type Unspecified | |
TX | 088986701 | Medicaid | |
TX | R70018 | Medicare UPIN | |
TX | 8L27588 | Medicare PIN | |
TX | TXB111127 | Medicare PIN |