Provider Demographics
NPI:1851991459
Name:WALKER, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9017 LARRIMORE LN
Mailing Address - Street 2:
Mailing Address - City:BELEWS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27009-9112
Mailing Address - Country:US
Mailing Address - Phone:336-455-1863
Mailing Address - Fax:
Practice Address - Street 1:770 PARK CENTRE DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3598
Practice Address - Country:US
Practice Address - Phone:704-780-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherN/A