Healthcare Provider Details

I. General information

NPI: 1487459897
Provider Name (Legal Business Name): LATOYA WALKER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 N PROSPECT AVE STE 304
MILWAUKEE WI
53202-6306
US

IV. Provider business mailing address

2022 E EDGEWOOD AVE
SHOREWOOD WI
53211-2935
US

V. Phone/Fax

Practice location:
  • Phone: 414-405-0670
  • Fax:
Mailing address:
  • Phone: 414-405-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number22799930
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1656633
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: