Provider Demographics
NPI:1326739087
Name:WALKER, JASON ARTHUR (BC-FNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ARTHUR
Last Name:WALKER
Suffix:
Gender:M
Credentials:BC-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-478-4201
Mailing Address - Fax:
Practice Address - Street 1:12404 LIMA CROSSING DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-0202
Practice Address - Country:US
Practice Address - Phone:260-458-3740
Practice Address - Fax:260-458-3741
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013887A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily