1265535306 NPI number — KATHLEEN M WALKER RN PWD APRN

Table of content: (NPI 1942384367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265535306 NPI number — KATHLEEN M WALKER RN PWD APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
KATHLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN PWD APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265535306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9054
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-9054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-467-3600
Provider Business Mailing Address Fax Number:
423-467-3696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CORNER OF SYDNEY ST & LAMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-966-1171
Provider Business Practice Location Address Fax Number:
423-224-1321
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364S00000X , with the licence number:  APRN6989 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010149517 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3134309 . This is a "MAGELLAN NAVIGATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 334969 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "INITIAL GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN LEASE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010149843 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3134309 . This is a "MAGELLAN PINNACLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3904387 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620582605 . This is a "BEECH STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP WORKCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN SENIOR PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605G5 . This is a "UBH JOHN DEERE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3134309 . This is a "MAGELLAN SUMMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3729687 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620582605 . This is a "CARITEN PHP POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 620582605 . This is a "CARITEN PHP HMO" identifier . This identifiers is of the category "OTHER".




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