Healthcare Provider Details

I. General information

NPI: 1558266676
Provider Name (Legal Business Name): MARA WALKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASHLAND DR STE 301
ASHLAND KY
41101-7097
US

IV. Provider business mailing address

1000 ASHLAND DR STE 301
ASHLAND KY
41101-7097
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-3143
  • Fax: 606-325-8486
Mailing address:
  • Phone: 606-408-3143
  • Fax: 606-325-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4058321
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: