Healthcare Provider Details

I. General information

NPI: 1174428254
Provider Name (Legal Business Name): CAITLYN RENEE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 BROOKGREEN WAY
SAINT AUGUSTINE FL
32092-3368
US

IV. Provider business mailing address

376 BROOKGREEN WAY
SAINT AUGUSTINE FL
32092-3368
US

V. Phone/Fax

Practice location:
  • Phone: 443-619-0552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number37467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: