Provider Demographics
NPI:1649636465
Name:WALKER, SANDRA LARS
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LARS
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 1:3004 KNIGHT ST STE 149
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2502
Mailing Address - Country:US
Mailing Address - Phone:318-426-2597
Mailing Address - Fax:318-426-2597
Practice Address - Street 1:3304 KNIGHT STREET
Practice Address - Street 2:SUITE #149
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-426-2597
Practice Address - Fax:318-426-2597
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator