Provider Demographics
NPI:1801050414
Name:WALKER, DELINA KATHERINE (LSA)
Entity type:Individual
Prefix:
First Name:DELINA
Middle Name:KATHERINE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LSA
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 1198
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-1198
Mailing Address - Country:US
Mailing Address - Phone:210-264-1728
Mailing Address - Fax:
Practice Address - Street 1:186 BIG OAK DR
Practice Address - Street 2:
Practice Address - City:ADKINS
Practice Address - State:TX
Practice Address - Zip Code:78101-2753
Practice Address - Country:US
Practice Address - Phone:830-217-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00578363AS0400X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00578OtherLICENSED SURGICAL ASSISTANT