MEDICARE: MRS. KELLY ELISABETH WALKER RN

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	26NO12344300	NJ
2	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	26NO12344300	NJ

General Provider Information

NPI Number	:	1316185259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY ELISABETH WALKER RN

Provider Business Mailing Address
First Line	:	1395 CHEWS LANDING RD
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2760
Country	:	US
Telephone Number	:	856-282-2050
Fax Number	:	856-352-6713

Provider Business Practice Location Address
First Line	:	1395 CHEWS LANDING RD
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-2760
Country	:	US
Telephone Number	:	856-282-2050
Fax Number	:	856-352-6713

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

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	03/11/2019

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