Provider Demographics
NPI:1801051560
Name:WALKER, BETTINA BRIDGFORD (MD)
Entity type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:BRIDGFORD
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BETTINA
Other - Middle Name:N/A
Other - Last Name:BRIDGFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3840 HULEN ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7277
Mailing Address - Country:US
Mailing Address - Phone:817-569-4523
Mailing Address - Fax:817-569-4462
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:SUITE 125
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-569-4523
Practice Address - Fax:817-569-4462
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN19492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283890601Medicaid
TX8CT321OtherBLUE CROSS BLUE SHIELD
TX283890601Medicaid