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General NPI Number Information
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NPI Number | 1013971761
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Entity Type | Individual
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Provider Name | BRENDA MOODY WALKER RN,MSN,CFNP
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Gender | Female
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 4407 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-2541
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Country | US
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Telephone | 304-925-0392
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Fax | 304-825-0392
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Provider Business Mailing Address
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Address Line | 2585 3RD AVE
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City | HUNTINGTON
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State | WV
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Zip | 25703-1642
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Country | US
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Telephone | 304-697-1396
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Fax | 304-697-2086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 18804
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License Number State | WV
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