Healthcare Provider Details

I. General information

NPI: 1033869623
Provider Name (Legal Business Name): ELIZABETH WALKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 04/15/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 E CLARK AVE STE I
SANTA MARIA CA
93455-5171
US

IV. Provider business mailing address

1145 E CLARK AVE STE I
SANTA MARIA CA
93455-5171
US

V. Phone/Fax

Practice location:
  • Phone: 267-828-4817
  • Fax: 805-556-4889
Mailing address:
  • Phone: 267-828-4817
  • Fax: 805-556-4889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95103901
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number95103901
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034706
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number95034706
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95034706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: