Provider Demographics
NPI:1295021541
Name:WALKER, JEFFERY L (FNP)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:L
Last Name:WALKER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-1619
Mailing Address - Country:US
Mailing Address - Phone:828-695-5900
Mailing Address - Fax:828-695-4256
Practice Address - Street 1:109 ROCK BARN RD NE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9727
Practice Address - Country:US
Practice Address - Phone:828-994-4898
Practice Address - Fax:828-994-4898
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005188363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1124559331Medicaid
NC1295021541Medicaid
NC7004992Medicaid
NC1295021541Medicaid