Healthcare Provider Details

I. General information

NPI: 1881060754
Provider Name (Legal Business Name): PHILLIP G. WALKER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ANDREA ST SUITE 205
BOWLING GREEN KY
42104-3382
US

IV. Provider business mailing address

1300 ANDREA ST SUITE 205
BOWLING GREEN KY
42104-3382
US

V. Phone/Fax

Practice location:
  • Phone: 270-205-4585
  • Fax: 270-936-7333
Mailing address:
  • Phone: 270-205-4585
  • Fax: 270-936-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3009635
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: