Provider Demographics
NPI:1023768702
Name:WALKER, ALICIA LYNN (RDH)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LYNN
Other - Last Name:SLAUGHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8553 CARL VALENTINE CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4950
Mailing Address - Country:US
Mailing Address - Phone:865-724-3911
Mailing Address - Fax:
Practice Address - Street 1:1905 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5401
Practice Address - Country:US
Practice Address - Phone:865-983-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH0000003956124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist