Healthcare Provider Details

I. General information

NPI: 1063850477
Provider Name (Legal Business Name): PAULA LENORE WALKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WOODBRIDGE SUITE A
SOMERVILLE TN
38068
US

IV. Provider business mailing address

25 WOODBRIDGE SUITE A
SOMERVILLE TN
38068
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-6353
  • Fax: 901-465-5948
Mailing address:
  • Phone: 901-465-6353
  • Fax: 901-465-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17642
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: