Provider Demographics
NPI:1699986349
Name:WALKER, SUSANNAH P (MD)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:P
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 E 70TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5053
Mailing Address - Country:US
Mailing Address - Phone:318-681-7920
Mailing Address - Fax:
Practice Address - Street 1:1549 E 70TH ST
Practice Address - Street 2:STE 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5053
Practice Address - Country:US
Practice Address - Phone:318-681-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD202469208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1079235Medicaid
LA07923Medicaid