Provider Demographics
NPI:1376807040
Name:WALKER, MARK W (FNP-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:WALKER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:NATURITA
Mailing Address - State:CO
Mailing Address - Zip Code:81422-0340
Mailing Address - Country:US
Mailing Address - Phone:970-865-2665
Mailing Address - Fax:970-865-2764
Practice Address - Street 1:421 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NATURITA
Practice Address - State:CO
Practice Address - Zip Code:81422-5018
Practice Address - Country:US
Practice Address - Phone:970-865-2665
Practice Address - Fax:970-865-2674
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564634363LF0000X
COC-APN.0992626-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily