Provider Demographics
NPI:1316983620
Name:WALKER, ROSALYN C (MD)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:C
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:570 E WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4538
Mailing Address - Country:US
Mailing Address - Phone:601-576-7472
Mailing Address - Fax:601-576-7825
Practice Address - Street 1:570 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4538
Practice Address - Country:US
Practice Address - Phone:601-576-7472
Practice Address - Fax:601-576-7825
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS114332080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116555Medicaid
LA1677728Medicaid
LA1677728Medicaid
MS00116555Medicaid
MSE34475Medicare UPIN
MS302I379149Medicare PIN