Healthcare Provider Details

I. General information

NPI: 1538604095
Provider Name (Legal Business Name): SCOTT WALKER NP-C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 HANCOCK CT NE STE A
ALBUQUERQUE NM
87109-4594
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 505-322-2510
  • Fax: 505-639-5497
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SCOTT F WALKER
Title or Position: CEO
Credential: DC, CNP
Phone: 505-322-2510