Healthcare Provider Details

I. General information

NPI: 1891022026
Provider Name (Legal Business Name): NANCY CAROL-SAMSEL WALKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY CAROL SAMSEL

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL DR
JEFFERSON CITY TN
37760-5281
US

IV. Provider business mailing address

P.O. BOX 708760
SANDY UT
84070-8760
US

V. Phone/Fax

Practice location:
  • Phone: 865-471-2431
  • Fax: 865-471-2317
Mailing address:
  • Phone: 801-352-9500
  • Fax: 801-352-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000145354
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14413
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: