Provider Demographics
NPI:1215601943
Name:WALKER, CALVIN SHANNON (PMHNP)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:SHANNON
Last Name:WALKER
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 N. PIMA ROAD
Mailing Address - Street 2:SUITE 108 #1039
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:708-271-5802
Mailing Address - Fax:
Practice Address - Street 1:20715 N PIMA ROAD
Practice Address - Street 2:SUITE 108 #1039
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6685
Practice Address - Country:US
Practice Address - Phone:708-506-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ230428363LP0808X
IL209.025201363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health