Provider Demographics
NPI:1003826769
Name:WALKER, CATHY S (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:S
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E. DUPONT RD.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-480-2600
Mailing Address - Fax:260-496-8077
Practice Address - Street 1:1234 E. DUPONT RD.
Practice Address - Street 2:SUITE 6
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1545
Practice Address - Country:US
Practice Address - Phone:260-480-2600
Practice Address - Fax:260-496-8077
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000608A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000549119OtherANTHEM
IN200287230Medicaid
IN200287230Medicaid
S75852Medicare UPIN