Provider Demographics
NPI:1003426396
Name:WALKER, ROLLIE S (APRN)
Entity Type:Individual
Prefix:
First Name:ROLLIE
Middle Name:S
Last Name:WALKER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:870-448-3767
Practice Address - Street 1:1002 N SPRING STREET
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2918
Practice Address - Country:US
Practice Address - Phone:870-741-6373
Practice Address - Fax:870-741-5102
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK86183363LF0000X
AR223719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR223719OtherARKANSAS STATE BOARD OF NURSING