Provider Demographics
NPI:1588375638
Name:WALKER, STACY R (CSFA)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:R
Last Name:WALKER
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S FLEISHEL AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2067
Mailing Address - Country:US
Mailing Address - Phone:903-606-1410
Mailing Address - Fax:903-606-1100
Practice Address - Street 1:619 S FLEISHEL AVE STE 203
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2067
Practice Address - Country:US
Practice Address - Phone:903-606-1410
Practice Address - Fax:903-606-1100
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214242246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant