Provider Demographics
NPI:1043629900
Name:DYER, WALKER (APRN)
Entity type:Individual
Prefix:
First Name:WALKER
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 BUTTERFIELD COACH RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-9142
Mailing Address - Country:US
Mailing Address - Phone:479-757-5023
Mailing Address - Fax:
Practice Address - Street 1:2000 S 42ND ST
Practice Address - Street 2:STE 100
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-2001
Practice Address - Country:US
Practice Address - Phone:479-273-9173
Practice Address - Fax:479-464-9989
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily