Healthcare Provider Details

I. General information

NPI: 1659235653
Provider Name (Legal Business Name): LATOYA NICOLE WALKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 CENTRAL AVE
MEMPHIS TN
38104-5064
US

IV. Provider business mailing address

1642 CENTRAL AVE
MEMPHIS TN
38104-5064
US

V. Phone/Fax

Practice location:
  • Phone: 901-409-3299
  • Fax:
Mailing address:
  • Phone: 901-409-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number149243
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: