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NPI Code Detail

MEDICARE: MRS. KRISTEN MARIE WALK APRN

MEDICARE: MRS. KRISTEN MARIE WALK APRN
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
1363LF0000XFamily Nurse Practitioner209020263IL

General Provider Information

NPI Number : 1285276162
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTEN MARIE WALK APRN
Provider Business Mailing Address
First Line : PO BOX 372
Second Line :
City : MATTOON
State : IL
Zip : 61938-0372
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2040 LINCOLN AVE STE 100
Second Line :
City : CHARLESTON
State : IL
Zip : 61920-3197
Country : US
Telephone Number : 217-345-2030
Fax Number : 217-345-2045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2019
Last Update Date : 03/26/2026

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