Healthcare Provider Details

I. General information

NPI: 1386513646
Provider Name (Legal Business Name): MADISON LEAH WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 BATTERY PARK DR
GLENDALE KY
42740-8800
US

IV. Provider business mailing address

607 SUNRISE LN
ELIZABETHTOWN KY
42701-2207
US

V. Phone/Fax

Practice location:
  • Phone: 270-779-5319
  • Fax:
Mailing address:
  • Phone: 270-779-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number1177541
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: