Healthcare Provider Details

I. General information

NPI: 1730731498
Provider Name (Legal Business Name): ERIN GAIL WALKLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN GAIL OWEN

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 BEACON ST
COLORADO SPRINGS CO
80907-9208
US

IV. Provider business mailing address

5680 ASTORIA WAY
COLORADO SPRINGS CO
80919-5401
US

V. Phone/Fax

Practice location:
  • Phone: 719-888-8097
  • Fax:
Mailing address:
  • Phone: 281-536-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007574
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: