1831288471 NPI number — REBECCA L WALKER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831288471 NPI number — REBECCA L WALKER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WALKER

Provider First Name:

REBECCA

Provider Middle Name:

L

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1831288471

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/01/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 99213

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FORT WORTH

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

76199-0213

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

682-885-4471

Provider Business Mailing Address Fax Number:

682-885-3939

Provider First Line Business Practice Location Address:

6316 PRECINCT LINE RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HURST

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

76054-2766

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

817-605-2504

Provider Business Practice Location Address Fax Number:

817-605-2505

Provider Enumeration Date:

10/12/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  E3796 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 125290007 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 0003GS . This is a "BCBSTX GRP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 124068 . This is a "SUPERIOR PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 1416131 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 125290004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 170994101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 8Z1880 . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 163314101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 1124098447 . This is a "GRP NPI NUMBER" identifier . This identifiers is of the category "OTHER".
• Identifier: 125290008 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 4057626 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 080626701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".