Provider Demographics
NPI:1346645454
Name:WALKER, TANYA Y (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:Y
Last Name:WALKER
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W. CHARLESTON BLVD. STE. 508
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2688
Mailing Address - Fax:702-623-4727
Practice Address - Street 1:11860 SOUTHERN HIGHLANDS PARKWAY, SUITE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141
Practice Address - Country:US
Practice Address - Phone:702-383-2273
Practice Address - Fax:702-224-7180
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002351363LA2200X
IL209.012528363LA2200X
NV002351363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1346645454Medicaid