Healthcare Provider Details

I. General information

NPI: 1104385335
Provider Name (Legal Business Name): ASHLEY RENEE WALKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W WASHINGTON ST
PITTSFIELD IL
62363-1350
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-2113
  • Fax: 217-285-5126
Mailing address:
  • Phone: 217-223-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019031
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: