Provider Demographics
NPI:1851063291
Name:WALKER, DARRELL DURELL JR (LMT 1824)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:DURELL
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:LMT 1824
Other - Prefix:
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Mailing Address - Street 1:119 CLIFF WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-5026
Mailing Address - Country:US
Mailing Address - Phone:769-226-1925
Mailing Address - Fax:
Practice Address - Street 1:5430 EXECUTIVE PL STE 2C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4134
Practice Address - Country:US
Practice Address - Phone:769-226-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS1824225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist