Provider Demographics
NPI:1750120564
Name:WALKER, SHERLISA LINETTE
Entity type:Individual
Prefix:
First Name:SHERLISA
Middle Name:LINETTE
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:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:AR
Mailing Address - Zip Code:72053-0168
Mailing Address - Country:US
Mailing Address - Phone:501-744-7450
Mailing Address - Fax:
Practice Address - Street 1:15000 CHENAL PKWY APT F201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2062
Practice Address - Country:US
Practice Address - Phone:501-744-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X, 332B00000X
AR1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies