Individual
RANDY WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
INTREPID SPIRIT CLINIC 36029 58TH STREET, FORT CAVAZOS, TX 76544
(703) 347-3190
Mailing address
36065 SANTA FE AVE, FORT CAVAZOS, TX 76544-5060
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
149902
TX
Other
Enumeration date
05/04/2021
Last updated
02/12/2025
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