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General NPI Number Information
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NPI Number | 1245533884
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Entity Type | Individual
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Provider Name | JESSICA BLACK WALKER MSN, CPNP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 650 NEWTOWN PIKE
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City | LEXINGTON
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State | KY
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Zip | 40508-1113
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Country | US
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Telephone | 615-364-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 650 NEWTOWN PIKE
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City | LEXINGTON
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State | KY
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Zip | 40508-1113
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Country | US
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Telephone | 615-364-5510
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0000015422
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 3007468
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License Number State | KY
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