Healthcare Provider Details

I. General information

NPI: 1629521646
Provider Name (Legal Business Name): THOMAS PATRICK WALKER F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16745 W BERNARDO DR
SAN DIEGO CA
92127-1907
US

IV. Provider business mailing address

6400 SHAFER CT STE 700
ROSEMONT IL
60018-4989
US

V. Phone/Fax

Practice location:
  • Phone: 858-592-2000
  • Fax:
Mailing address:
  • Phone: 346-376-1702
  • Fax: 224-532-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004279
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number841520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: