Provider Demographics
NPI:1447357454
Name:WALKER, ROBERT DAVID (CRNP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DAVID
Last Name:WALKER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 BROADWAY AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4609
Mailing Address - Country:US
Mailing Address - Phone:330-219-4249
Mailing Address - Fax:
Practice Address - Street 1:413 BROADWAY AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4609
Practice Address - Country:US
Practice Address - Phone:330-219-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.00123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.001.23OtherLICENSE NUMBER
OHCTP-213 RXOtherCERTIFICATE TO PRESCRIBE
OHMW0557479OtherDEA LICENSE NUMBER
OHCTP-213 RXOtherCERTIFICATE TO PRESCRIBE
S04808Medicare UPIN