Provider Demographics
NPI:1104185180
Name:WALKER, JENNIFER (PA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4040 WEST DAYBREAK PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1288
Mailing Address - Country:US
Mailing Address - Phone:801-266-1474
Mailing Address - Fax:801-878-9164
Practice Address - Street 1:1548 EAST 4500 SOUTH SUITE 202
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5209
Practice Address - Country:US
Practice Address - Phone:801-266-8841
Practice Address - Fax:801-266-0449
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCPA030842363A00000X
VA0110003465363A00000X
UT9291448-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant