Provider Demographics
NPI:1255020988
Name:BOOD, PROMISE WALKER (MD)
Entity type:Individual
Prefix:
First Name:PROMISE
Middle Name:WALKER
Last Name:BOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PROMISE
Other - Middle Name:RENAY
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2303 CLOUDCROFT CIR APT B
Mailing Address - Street 2:
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8373
Mailing Address - Country:US
Mailing Address - Phone:575-921-4412
Mailing Address - Fax:
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-215-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10085732390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program