Healthcare Provider Details

I. General information

NPI: 1174201511
Provider Name (Legal Business Name): JANA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10566 N HIGHWAY 191
ELFRIDA AZ
85610-9021
US

IV. Provider business mailing address

3040 W CONAWAY CIR
BENSON AZ
85602-3001
US

V. Phone/Fax

Practice location:
  • Phone: 520-642-2222
  • Fax:
Mailing address:
  • Phone: 505-793-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number294586
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: