Healthcare Provider Details

I. General information

NPI: 1588581342
Provider Name (Legal Business Name): TIFFANY LARENE WALKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S FRONTAGE RD W STE 2700
VAIL CO
81657-5038
US

IV. Provider business mailing address

PO BOX 6931
AVON CO
81620-6931
US

V. Phone/Fax

Practice location:
  • Phone: 970-569-3240
  • Fax: 866-725-4659
Mailing address:
  • Phone: 970-569-3240
  • Fax: 866-725-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN.1642582
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: