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General NPI Number Information
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NPI Number | 1285286831
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Entity Type | Individual
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Provider Name | DEREK N WALCKER PMHNP
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Gender | Male
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Dates
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Enumeration Date | 07/14/2019
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Last Update Date | 08/16/2020
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Provider Practice Location Address
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Address Line | 5850 WATERLOO RD STE 140
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City | COLUMBIA
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State | MD
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Zip | 21045-1944
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Country | US
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Telephone | 410-988-2503
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Fax | 410-343-7899
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Provider Business Mailing Address
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Address Line | 3814 PLUM MEADOW DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-5126
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Country | US
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Telephone | 240-723-2671
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.025119
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R189093
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License Number State | MD
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