Provider Demographics
NPI:1396628772
Name:WALKER, IDELL
Entity type:Individual
Prefix:
First Name:IDELL
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 JEFFERSON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4502
Mailing Address - Country:US
Mailing Address - Phone:757-995-6036
Mailing Address - Fax:757-527-2567
Practice Address - Street 1:2506 JEFFERSON AVE STE 111
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4502
Practice Address - Country:US
Practice Address - Phone:757-995-6036
Practice Address - Fax:757-527-2567
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker