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General NPI Number Information
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NPI Number | 1336514074
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Entity Type | Individual
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Provider Name | MRS. COURTNEY BENNETT WALKER
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Gender | Female
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 130 N GROSS RD STE 201
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City | KINGSLAND
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State | GA
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Zip | 31548-6277
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Country | US
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Telephone | 912-729-2795
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Fax |
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Provider Business Mailing Address
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Address Line | 308 LONG POINT CIR
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City | SAINT MARYS
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State | GA
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Zip | 31558-4384
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Country | US
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Telephone | 904-699-8268
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 313498
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9281279
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 313498
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License Number State | GA
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