Healthcare Provider Details

I. General information

NPI: 1912827650
Provider Name (Legal Business Name): VALETTA MOUPHY WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALETTA MOUPHY WALKER-NORMAN

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1710
US

IV. Provider business mailing address

3650 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1710
US

V. Phone/Fax

Practice location:
  • Phone: 703-758-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198139
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: