Provider Demographics
NPI:1275668162
Name:WALKER, STEPHANIE M (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 SUNNYBROOK DR
Mailing Address - Street 2:SUITE E-141
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4203
Mailing Address - Country:US
Mailing Address - Phone:712-266-2760
Mailing Address - Fax:712-266-2789
Practice Address - Street 1:5885 SUNNYBROOK DR
Practice Address - Street 2:SUITE E-141
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4203
Practice Address - Country:US
Practice Address - Phone:712-266-2760
Practice Address - Fax:712-266-2789
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001770363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAQ76568Medicare UPIN
IAI19543Medicare PIN