Provider Demographics
NPI:1487882700
Name:WALKER, AMY R (DDS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 NE 20 RD
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:KS
Mailing Address - Zip Code:67003-9035
Mailing Address - Country:US
Mailing Address - Phone:620-842-2661
Mailing Address - Fax:
Practice Address - Street 1:3 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-1531
Practice Address - Country:US
Practice Address - Phone:620-845-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist