Healthcare Provider Details

I. General information

NPI: 1154591295
Provider Name (Legal Business Name): ALICIA D WALKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA D KRAFT NP

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11934 W BROAD ST STE 200
RICHMOND VA
23233-1100
US

IV. Provider business mailing address

11934 W BROAD ST STE 200
RICHMOND VA
23233-1100
US

V. Phone/Fax

Practice location:
  • Phone: 804-423-2100
  • Fax: 804-716-5057
Mailing address:
  • Phone: 804-423-2100
  • Fax: 804-716-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024165281
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: