Provider Demographics
NPI:1972032159
Name:STUTTS-WALKER, SHERICE SHUNTA
Entity Type:Individual
Prefix:MS
First Name:SHERICE
Middle Name:SHUNTA
Last Name:STUTTS-WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHERCE
Other - Middle Name:SHUNTA
Other - Last Name:STUTTS-WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6451 HOMEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-7814
Mailing Address - Country:US
Mailing Address - Phone:601-202-2908
Mailing Address - Fax:601-510-9691
Practice Address - Street 1:6451 HOMEWOOD CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7814
Practice Address - Country:US
Practice Address - Phone:601-202-2908
Practice Address - Fax:601-510-9691
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20170189623747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant