Provider Demographics
NPI:1073107736
Name:WALKER, JILL ELLYN (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELLYN
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:VACLAVIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1052 FIVE COVES TRCE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2011 NASHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3162
Practice Address - Country:US
Practice Address - Phone:615-230-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily