Healthcare Provider Details

I. General information

NPI: 1790616431
Provider Name (Legal Business Name): DEREK JAMES WALKER MSN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E 750 N
OREM UT
84097-4345
US

IV. Provider business mailing address

1383 S 1500 W
SPRINGVILLE UT
84663-5524
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-2273
  • Fax:
Mailing address:
  • Phone: 891-852-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7236868-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: