Provider Demographics
NPI:1033707096
Name:WALKER, SHEMIKA LATRICE
Entity Type:Individual
Prefix:
First Name:SHEMIKA
Middle Name:LATRICE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NORTHEAST DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-7303
Mailing Address - Country:US
Mailing Address - Phone:478-319-0019
Mailing Address - Fax:
Practice Address - Street 1:3780 BLOOMFIELD VILLAGE DR STE 1
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-0806
Practice Address - Country:US
Practice Address - Phone:478-633-5500
Practice Address - Fax:478-784-3528
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily