Basic Information
Provider Information
NPI: 1962813600
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALKER
FirstName: DANIELLE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5865
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794085865
CountryCode: US
TelephoneNumber: 8067432898
FaxNumber: 8067432787
Practice Location
Address1: 4015 22ND PL
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794101119
CountryCode: US
TelephoneNumber: 8067256490
FaxNumber: 8067236714
Other Information
ProviderEnumerationDate: 05/15/2014
LastUpdateDate: 10/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XR2498TXN Allopathic & Osteopathic PhysiciansHospitalist 
208000000XR2498TXY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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