MEDICARE: CONNIE WALKER

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	363L00000X	Nurse Practitioner	SP013898	PA
2	363L00000X	Nurse Practitioner	R207755	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497183818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE WALKER

Provider Business Mailing Address
First Line	:	72 GREENE ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2933
Country	:	US
Telephone Number	:	301-682-2041
Fax Number	:	301-732-6295

Provider Business Practice Location Address
First Line	:	72 GREENE ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2933
Country	:	US
Telephone Number	:	301-682-2041
Fax Number	:	301-732-6295

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

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	02/19/2025

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Directions to “ CONNIE WALKER ” Practice Location

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