1265586259 NPI number — DR. SHERRI LEE WALKER D. O.

Table of content: DR. SHERRI LEE WALKER D. O. (NPI 1265586259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265586259 NPI number — DR. SHERRI LEE WALKER D. O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
SHERRI
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D. O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICKETT-SPARLIN
Provider Other First Name:
SHERRI
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265586259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
341 FAVRE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37398-5365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-897-1260
Provider Business Mailing Address Fax Number:
931-967-8226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1383 S COLLEGE ST
Provider Second Line Business Practice Location Address:
STE. 2
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37398-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-810-8012
Provider Business Practice Location Address Fax Number:
931-241-6630
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2308 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1526761 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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