Provider Demographics
NPI:1306976832
Name:WALKER, STACIE LYN
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:LYN
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:STACIE
Other - Middle Name:LYN
Other - Last Name:METTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-6601
Mailing Address - Fax:661-868-6666
Practice Address - Street 1:1600 E BELLE TER
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-3880
Practice Address - Country:US
Practice Address - Phone:661-635-2950
Practice Address - Fax:661-635-2983
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator