MEDICARE: MS. CHARLOTTE REEVES WALYKO MA, LPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1699	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04579	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073577284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARLOTTE REEVES WALYKO MA, LPA

Provider Business Mailing Address
First Line	:	PO BOX 2161
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-7161
Country	:	US
Telephone Number	:	252-537-6164
Fax Number	:	252-537-9199

Provider Business Practice Location Address
First Line	:	854 COUNTRY CLUB RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1706
Country	:	US
Telephone Number	:	252-972-9903
Fax Number	:	252-451-1540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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