Provider Demographics
NPI:1093727984
Name:WALKER, MARY (NP-C (ARNP))
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP-C (ARNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138-2430
Mailing Address - Country:US
Mailing Address - Phone:641-828-7141
Mailing Address - Fax:
Practice Address - Street 1:1515 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3399
Practice Address - Country:US
Practice Address - Phone:641-842-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA059208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily