Provider Demographics
NPI:1407441942
Name:WALKER, STACY (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3635
Mailing Address - Country:US
Mailing Address - Phone:385-430-1430
Mailing Address - Fax:385-430-0710
Practice Address - Street 1:3535 S MARKET ST
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3635
Practice Address - Country:US
Practice Address - Phone:385-430-1430
Practice Address - Fax:385-430-0710
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8199325-4405363LF0000X
CO0996345363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty