MEDICARE: MR. GEORGE EARL WALKER JR.

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	364SE0003X	Emergency Clinical Nurse Specialist	RN9508045	FL

General Provider Information

NPI Number	:	1508444357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE EARL WALKER JR.

Provider Business Mailing Address
First Line	:	259 SW VENTURA LN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-3176
Country	:	US
Telephone Number	:	386-697-9096
Fax Number	:

Provider Business Practice Location Address
First Line	:	259 SW VENTURA LN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-3176
Country	:	US
Telephone Number	:	386-697-9096
Fax Number	:

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

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	04/01/2021

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