Provider Demographics
NPI:1669404935
Name:WALKER, JAMES RANDALL (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDALL
Last Name:WALKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SOUTH FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72075
Mailing Address - Country:US
Mailing Address - Phone:501-985-0292
Mailing Address - Fax:501-985-2070
Practice Address - Street 1:707 SOUTH FIRST STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72075
Practice Address - Country:US
Practice Address - Phone:501-985-0292
Practice Address - Fax:501-985-2070
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8811020101Y00000X
ARM9710027106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR55364Medicare ID - Type Unspecified