Provider Demographics
NPI:1285183616
Name:WALKER, DUSTTON (APRN)
Entity Type:Individual
Prefix:MR
First Name:DUSTTON
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:APRN
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 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:510 RUBY DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2168
Practice Address - Country:US
Practice Address - Phone:270-399-7900
Practice Address - Fax:270-399-7910
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK213820OtherMEDICARE PTAN
KYK213821OtherMEDICARE PTAN
KY7100444050Medicaid