Healthcare Provider Details

I. General information

NPI: 1629149067
Provider Name (Legal Business Name): BEVERLEY P WALKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE NW
WINTER HAVEN FL
33881-4679
US

IV. Provider business mailing address

550 POPE AVE NW
WINTER HAVEN FL
33881-4679
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-2144
  • Fax: 863-293-3732
Mailing address:
  • Phone: 863-293-2144
  • Fax: 863-293-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3581
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA3581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: