Provider Demographics
NPI:1952804825
Name:WALKER, JASON ANDREW
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANDREW
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HALL DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-1126
Mailing Address - Country:US
Mailing Address - Phone:575-704-9738
Mailing Address - Fax:
Practice Address - Street 1:1201 HALL DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-1126
Practice Address - Country:US
Practice Address - Phone:575-704-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician