Provider Demographics
NPI:1164703401
Name:WALKLEY, SUSAN N (NP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:N
Last Name:WALKLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:LIGHTFOOT
Mailing Address - State:VA
Mailing Address - Zip Code:23090-0087
Mailing Address - Country:US
Mailing Address - Phone:757-941-5095
Mailing Address - Fax:757-565-2947
Practice Address - Street 1:5477 MOORETOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2108
Practice Address - Country:US
Practice Address - Phone:757-565-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169579363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN