=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245041003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYLIN WALKER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2025
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2066 W MAIN ST STE 130
-----------------------------------------------------
City | XENIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45385-2882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-372-7583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9922 HOLLOW TREE DR
-----------------------------------------------------
City | TIPP CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45371-9198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-344-8836
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------