Healthcare Provider Details

I. General information

NPI: 1609257567
Provider Name (Legal Business Name): PATRINA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CORVETTE DR
WILLIAMSBURG VA
23185-5284
US

IV. Provider business mailing address

114 CORVETTE DR
WILLIAMSBURG VA
23185-5284
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-7999
  • Fax: 757-253-7551
Mailing address:
  • Phone: 757-564-7999
  • Fax: 757-253-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberT61926897
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: