Healthcare Provider Details

I. General information

NPI: 1396731808
Provider Name (Legal Business Name): NORMAN LEE WALKER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 06/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RELAY ROAD
ANGOON AK
99820
US

IV. Provider business mailing address

725 RELAY ROAD
ANGOON AK
99820
US

V. Phone/Fax

Practice location:
  • Phone: 907-788-4600
  • Fax: 907-788-4601
Mailing address:
  • Phone: 907-788-4600
  • Fax: 907-788-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number771
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number43492
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3167
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number210208
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: