Individual
JENNIE WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
85 SIERRA PARK RD, MAMMOTH LAKES, CA 93546-2073
(760) 934-3311
Mailing address
PO BOX 2485, MAMMOTH LAKES, CA 93546-2485
(760) 934-3311
(760) 924-4003
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A73644
CA
282NC0060X
Critical Access Hospital
A73644
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558371229
—
CA
Enumeration date
08/08/2006
Last updated
01/09/2021
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