Healthcare Provider Details

I. General information

NPI: 1043128820
Provider Name (Legal Business Name): NOAH B WALKER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W HONKER DR
MERIDIAN ID
83642-7713
US

IV. Provider business mailing address

1111 W HONKER DR
MERIDIAN ID
83642-7713
US

V. Phone/Fax

Practice location:
  • Phone: 812-671-9588
  • Fax:
Mailing address:
  • Phone: 812-671-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6681724
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: