Healthcare Provider Details

I. General information

NPI: 1003865486
Provider Name (Legal Business Name): CAROLYN R WALKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 HICKMAN RD
URBANDALE IA
50322-4805
US

IV. Provider business mailing address

1734 NW 108TH ST
CLIVE IA
50325-7026
US

V. Phone/Fax

Practice location:
  • Phone: 515-727-4141
  • Fax:
Mailing address:
  • Phone: 515-223-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA075984
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: