Provider Demographics
NPI:1134722424
Name:WALKER, CASEY L
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:L
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 1:4425 JEFFERSON AVE STE 118A
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1529
Mailing Address - Country:US
Mailing Address - Phone:903-280-3323
Mailing Address - Fax:
Practice Address - Street 1:423 CLEAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-8993
Practice Address - Country:US
Practice Address - Phone:903-280-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies