Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 255983 | TX |
NPI | 1003121062 |
---|---|
Provider Name | Mrs. Mary Caroline Walker |
First Address | Amarillo, TX 79124-4907 |
Second Address | Amarillo, TX 79106-1770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2010 |
Last Update Date | 15/08/2010 |