Provider Demographics
NPI:1336514074
Name:WALKER, COURTNEY BENNETT
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BENNETT
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 LONG POINT CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4384
Mailing Address - Country:US
Mailing Address - Phone:904-699-8268
Mailing Address - Fax:
Practice Address - Street 1:130 N GROSS RD STE 201
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6277
Practice Address - Country:US
Practice Address - Phone:912-729-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA313498163WC0200X, 363LF0000X
FL9281279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse