Provider Demographics
NPI:1134489966
Name:WALKER, NIKITA SUE-ANN
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:SUE-ANN
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 1:118 FIVE FORKS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9025
Mailing Address - Country:US
Mailing Address - Phone:814-279-8316
Mailing Address - Fax:
Practice Address - Street 1:118 FIVE FORKS DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-9025
Practice Address - Country:US
Practice Address - Phone:814-279-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603235225200000X
WV001738225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant