Provider Demographics
NPI:1326062639
Name:WALKER, MARY LYNNE (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP
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 489
Mailing Address - Street 2:
Mailing Address - City:BELL BUCKLE
Mailing Address - State:TN
Mailing Address - Zip Code:37020-0489
Mailing Address - Country:US
Mailing Address - Phone:931-389-6875
Mailing Address - Fax:931-389-6889
Practice Address - Street 1:3003 FAIRFIELD PIKE
Practice Address - Street 2:
Practice Address - City:BELL BUCKLE
Practice Address - State:TN
Practice Address - Zip Code:37020-4212
Practice Address - Country:US
Practice Address - Phone:931-389-6875
Practice Address - Fax:931-389-6889
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5970363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01076010OtherAMERIGROUP
TN4165869OtherBLUE CROSS
TN1501372Medicaid
TN6197429OtherCIGNA
TN4165869OtherBLUE CROSS