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General NPI Number Information
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NPI Number | 1417353566
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Entity Type | Individual
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Provider Name | PHAEDRA LYNN WALKER APRN, DNP
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Gender | Female
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 4152 W BLUE HERON BLVD STE 123
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-4859
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Country | US
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Telephone | 440-844-7699
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Fax |
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Provider Business Mailing Address
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Address Line | 9047 ALEXANDRA CIR
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City | WELLINGTON
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State | FL
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Zip | 33414-6439
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Country | US
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Telephone | 561-223-2735
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9319140
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License Number State | FL
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