MEDICARE: JACKIE WALKER LM, CPM

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	174N00000X	Lactation Consultant (Non-RN)	10248671	OR
2	374J00000X	Doula
3	176B00000X	Midwife	421	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	421	OTHER	CA	CALIFORNIA MEDICAL BOARD
2	10183250	OTHER	OR	OREGON HEALTH AUTHORITY LICENSE

General Provider Information

NPI Number	:	1730578311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE WALKER LM, CPM

Provider Business Mailing Address
First Line	:	1417 NE TALBOTT DR
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-3544
Country	:	US
Telephone Number	:	805-610-3943
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 NE TALBOTT DR
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-3544
Country	:	US
Telephone Number	:	805-610-3943
Fax Number	:

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

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	12/29/2025

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Directions to “ JACKIE WALKER LM, CPM” Practice Location

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