Healthcare Provider Details

I. General information

NPI: 1184021263
Provider Name (Legal Business Name): CRAIG WALKER CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4588 PARADISE BLVD NW VIRTUAL URGENT CARE
ALBUQUERQUE NM
87114-4105
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-923-2070
  • Fax: 505-998-1710
Mailing address:
  • Phone: 505-923-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number58579
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: