Healthcare Provider Details

I. General information

NPI: 1427602507
Provider Name (Legal Business Name): JEANETTE LYNN WALKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 07/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 N CANYON RD
PROVO UT
84604-4571
US

IV. Provider business mailing address

3200 N CANYON RD
PROVO UT
84604-4571
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-3300
  • Fax: 801-354-7900
Mailing address:
  • Phone: 801-373-3300
  • Fax: 801-354-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0634936
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: