Provider Demographics
NPI:1124875802
Name:WALKER, KEISHA L
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 FULLER WISER RD APT 428
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3088
Mailing Address - Country:US
Mailing Address - Phone:225-266-1207
Mailing Address - Fax:
Practice Address - Street 1:1200 FULLER WISER RD
Practice Address - Street 2:APT428
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-3088
Practice Address - Country:US
Practice Address - Phone:225-266-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician