Individual
CRYSTAL DIANE WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 569-4039
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA07316
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285107301
—
TX
01
—
855N24
BCBS
TX
Enumeration date
06/23/2011
Last updated
04/25/2023
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