Healthcare Provider Details

I. General information

NPI: 1447229406
Provider Name (Legal Business Name): MARLA MICHELE WALKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 VAIL AVE STE 200
CHARLOTTE NC
28207-1222
US

IV. Provider business mailing address

4601 PARK RD SUITE 300
CHARLOTTE NC
28209-3239
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2564
  • Fax:
Mailing address:
  • Phone: 704-323-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9103268
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-03883
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: