1669422036 NPI number — THERESA M WALKER APN-C

Table of content: THERESA M WALKER APN-C (NPI 1669422036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669422036 NPI number — THERESA M WALKER APN-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
THERESA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN-C
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:
1669422036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98978
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-8978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-216-3346
Provider Business Mailing Address Fax Number:
702-671-6883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 WHITNEY RANCH DR
Provider Second Line Business Practice Location Address:
B6
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89014-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-547-0088
Provider Business Practice Location Address Fax Number:
702-434-1579
Provider Enumeration Date:
05/10/2006

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: 363LA2200X , with the licence number:  APN00328 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN12232 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: PENDING , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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