Provider Demographics
NPI:1366939282
Name:WALKER, DIANA CROCKETT (DPH)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:CROCKETT
Last Name:WALKER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 VETERANS DR N
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-6202
Mailing Address - Country:US
Mailing Address - Phone:731-431-8654
Mailing Address - Fax:
Practice Address - Street 1:180 VETERANS DR N
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-6202
Practice Address - Country:US
Practice Address - Phone:731-431-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist