Healthcare Provider Details

I. General information

NPI: 1861009664
Provider Name (Legal Business Name): GREGORY LAWRENCE WALKER II ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10624 S EASTERN AVE STE A-955
HENDERSON NV
89052-2982
US

IV. Provider business mailing address

10624 S EASTERN AVE STE A-955
HENDERSON NV
89052-2982
US

V. Phone/Fax

Practice location:
  • Phone: 702-407-7700
  • Fax: 702-407-7016
Mailing address:
  • Phone: 702-407-7700
  • Fax: 702-407-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number834774
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number834774
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number824774
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number834774
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: