Healthcare Provider Details

I. General information

NPI: 1659520898
Provider Name (Legal Business Name): NICOLE MARIE WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 PRYTANIA ST STE 410
NEW ORLEANS LA
70115-3574
US

IV. Provider business mailing address

3600 PRYTANIA ST STE 35
NEW ORLEANS LA
70115-3678
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-8681
  • Fax: 504-249-5311
Mailing address:
  • Phone: 504-897-8681
  • Fax: 504-249-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number065914
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number56595
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301100225
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number331523
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: