MEDICARE: SOMMER SHURAE WALKER PA-C

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	363AM0700X	Medical Physician Assistant	PA-756	AR

General Provider Information

NPI Number	:	1275048480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOMMER SHURAE WALKER PA-C

Provider Business Mailing Address
First Line	:	11001 EXECUTIVE CENTER DR STE 200
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4393
Country	:	US
Telephone Number	:	501-945-0392
Fax Number	:	501-945-0394

Provider Business Practice Location Address
First Line	:	3500 SPRINGHILL DR STE 200A
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2948
Country	:	US
Telephone Number	:	501-945-0392
Fax Number	:	501-945-0394

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	10/13/2021

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