MEDICARE: CASSAUNDRA WALCKER APRN, PNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	R39492	ND

General Provider Information

NPI Number	:	1437043312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSAUNDRA WALCKER APRN, PNP-PC

Provider Business Mailing Address
First Line	:	4019 CEDAR PL
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-6419
Country	:	US
Telephone Number	:	605-391-3522
Fax Number	:

Provider Business Practice Location Address
First Line	:	4019 CEDAR PL
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-6419
Country	:	US
Telephone Number	:	701-792-6112
Fax Number	:	701-792-7046

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

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	01/26/2026

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