Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP135608 | TX |
NPI | 1033621347 |
---|---|
Provider Name | Stanley Dean Walker JR. |
First Address | Crowley, TX 76036-2869 |
Second Address | Crowley, TX 76036-2869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2017 |
Last Update Date | 26/10/2017 |