Healthcare Provider Details

I. General information

NPI: 1669161931
Provider Name (Legal Business Name): AMY WALKA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4159 MARTHA BERRY HWY NW
ROME GA
30165-7705
US

IV. Provider business mailing address

102 W LAFAYETTE SQ STE 209
LA FAYETTE GA
30728-3520
US

V. Phone/Fax

Practice location:
  • Phone: 706-232-8477
  • Fax:
Mailing address:
  • Phone: 706-670-9818
  • Fax: 706-236-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN282079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: