Healthcare Provider Details

I. General information

NPI: 1497407001
Provider Name (Legal Business Name): MADISON BROOKE WALKER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 08/01/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22664 STATE ROUTE 73
WEST PORTSMOUTH OH
45663-6365
US

IV. Provider business mailing address

22664 STATE ROUTE 73
WEST PORTSMOUTH OH
45663-6365
US

V. Phone/Fax

Practice location:
  • Phone: 740-858-6656
  • Fax:
Mailing address:
  • Phone: 740-858-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0039599
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: