MEDICARE: MS. BEVERLEY P WALKER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA3581	FL
2	208000000X	Pediatrics Physician	PA3581	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629149067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLEY P WALKER PA-C

Provider Business Mailing Address
First Line	:	550 POPE AVE NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4679
Country	:	US
Telephone Number	:	863-293-2144
Fax Number	:	863-293-3732

Provider Business Practice Location Address
First Line	:	550 POPE AVE NW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4679
Country	:	US
Telephone Number	:	863-293-2144
Fax Number	:	863-293-3732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	11/07/2012

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