Provider Demographics
NPI:1891871141
Name:WALKER, DANA S (M D)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:S
Last Name:WALKER
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3990
Mailing Address - Country:US
Mailing Address - Phone:252-261-4187
Mailing Address - Fax:252-261-5182
Practice Address - Street 1:5200 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3990
Practice Address - Country:US
Practice Address - Phone:252-261-4187
Practice Address - Fax:252-261-5182
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985231Medicaid
NC0751030001Medicare NSC
NC8985231Medicaid
NC211237FMedicare PIN