Provider Demographics
NPI:1093093056
Name:WALKER, SHANAH DENISE (NP)
Entity Type:Individual
Prefix:
First Name:SHANAH
Middle Name:DENISE
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANAH
Other - Middle Name:DENISE
Other - Last Name:MARTUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9111 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3136
Mailing Address - Country:US
Mailing Address - Phone:318-212-5343
Mailing Address - Fax:318-212-5360
Practice Address - Street 1:9111 SUSAN DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3136
Practice Address - Country:US
Practice Address - Phone:318-212-5343
Practice Address - Fax:318-212-5360
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN121512-AP06572363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2158775Medicaid
LA3C578Medicare PIN