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General NPI Number Information
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NPI Number | 1538948112
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Entity Type | Individual
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Provider Name | KELLY WALKER STUDENT NP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 111 BEAUPRE DR
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City | LULING
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State | LA
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Zip | 70070-3035
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Country | US
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Telephone | 504-609-5737
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 111
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City | BOUTTE
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State | LA
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Zip | 70039-0111
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Country | US
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Telephone | 504-609-5737
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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 | RN128901
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License Number State | LA
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