Provider Demographics
NPI:1871214064
Name:WALKER-TARGET, CHANDRA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:
Last Name:WALKER-TARGET
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-6527
Mailing Address - Country:US
Mailing Address - Phone:318-751-2126
Mailing Address - Fax:
Practice Address - Street 1:3621 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-6527
Practice Address - Country:US
Practice Address - Phone:318-751-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA227128363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health