Individual
TARA T WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
106 HIGHLAND WAY STE 200, MADISON, MS 39110-6933
(601) 200-4141
(601) 200-4150
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4141
(601) 200-4150
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00514
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06934765
—
MS
01
—
1K0604
MEDICARE ST DOM
MS
01
—
PA00514
MS LICENSE
MS
Enumeration date
07/23/2020
Last updated
07/07/2021
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