Basic Information
Provider Information
NPI: 1003155151
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALKER
FirstName: SHANNON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
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Mailing Information
Address1: PO BOX 845347 UTSW
Address2:  
City: DALLAS
State: TX
PostalCode: 752847208
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 6201 HARRY HINES BLVD UTSW
Address2:  
City: DALLAS
State: TX
PostalCode: 753900010
CountryCode: US
TelephoneNumber: 2146482395
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/09/2013
LastUpdateDate: 12/06/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XR8509TXY Allopathic & Osteopathic PhysiciansHospitalist 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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