Healthcare Provider Details

I. General information

NPI: 1659788966
Provider Name (Legal Business Name): LOIS WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W MAIN ST
SOMERTON AZ
85350-6329
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-627-1120
  • Fax: 928-627-8773
Mailing address:
  • Phone: 928-662-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP9845
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR80468
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: