Healthcare Provider Details

I. General information

NPI: 1265346928
Provider Name (Legal Business Name): WILLIE ANNE WALKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 GEE GEE DR
OLIVE BRANCH MS
38654-6519
US

IV. Provider business mailing address

9210 GEE GEE DR
OLIVE BRANCH MS
38654-6519
US

V. Phone/Fax

Practice location:
  • Phone: 662-374-3885
  • Fax:
Mailing address:
  • Phone: 662-374-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908830
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: