Provider Demographics
NPI:1346448578
Name:WALKER, JAMES JACOB (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JACOB
Last Name:WALKER
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
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Mailing Address - Street 1:1000 DUTCH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9727
Mailing Address - Country:US
Mailing Address - Phone:724-773-1941
Mailing Address - Fax:724-773-8370
Practice Address - Street 1:1000 DUTCH RIDGE RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9727
Practice Address - Country:US
Practice Address - Phone:724-773-1941
Practice Address - Fax:724-773-8370
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053019363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2008236OtherHIGHMARK BS FREEDOM BLUE
PA50086686OtherCAPITAL BLUE CROSS
PA1566799OtherGATEWAY-WMG
PAP00432547Medicare PIN
PA114330FLTMedicare PIN