Provider Demographics
NPI:1427198233
Name:WALKER, DIANE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6655 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:FL
Mailing Address - Zip Code:32949-2221
Mailing Address - Country:US
Mailing Address - Phone:321-693-3325
Mailing Address - Fax:321-956-7571
Practice Address - Street 1:6655 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:FL
Practice Address - Zip Code:32949-2221
Practice Address - Country:US
Practice Address - Phone:321-693-3325
Practice Address - Fax:321-956-7571
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59541OtherBLUE CROSS & BLUE SHIELD
FL59541OtherBLUE CROSS & BLUE SHIELD
FLR92347Medicare UPIN
FL59541Medicare ID - Type Unspecified