Healthcare Provider Details

I. General information

NPI: 1164703401
Provider Name (Legal Business Name): SUSAN N WALKLEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5477 MOORETOWN RD
WILLIAMSBURG VA
23188-2108
US

IV. Provider business mailing address

PO BOX 87
LIGHTFOOT VA
23090-0087
US

V. Phone/Fax

Practice location:
  • Phone: 757-565-0106
  • Fax:
Mailing address:
  • Phone: 757-941-5095
  • Fax: 757-565-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169579
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: