Healthcare Provider Details

I. General information

NPI: 1225325483
Provider Name (Legal Business Name): LATOSHA K WALKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 112TH AVE SE STE 100
BELLEVUE WA
98004-6901
US

IV. Provider business mailing address

1400 112TH AVE SE STE 100
BELLEVUE WA
98004-6901
US

V. Phone/Fax

Practice location:
  • Phone: 425-891-0104
  • Fax:
Mailing address:
  • Phone: 425-891-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61377971
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number14991
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: