Individual
CARLY DIANE WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
611 N CENTRAL AVE, EUREKA, MO 63025-1232
(636) 579-2882
Mailing address
43 VESPER DR, ELLISVILLE, MO 63011-2213
(636) 579-2882
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2021004154
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/20/2020
Last updated
05/24/2021
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