=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306276837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE GARALDE WALKER FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2013
-----------------------------------------------------
Last Update Date | 01/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3750 S JONES BLVD STE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89103-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-444-7744
-----------------------------------------------------
Fax | 702-444-7898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9504 SUMMER CYPRESS ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89123-3930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-580-7997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | RN73810
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 817139
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------