Healthcare Provider Details

I. General information

NPI: 1861445611
Provider Name (Legal Business Name): ALEXANDER PEARCE WALKER ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W MAIN ST
HENDERSON TN
38340-2231
US

IV. Provider business mailing address

15 STONEBRIDGE BLVD
JACKSON TN
38305-2042
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-0001
  • Fax: 731-989-5151
Mailing address:
  • Phone: 731-660-2056
  • Fax: 731-661-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7653
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: