Provider Demographics
NPI:1417041088
Name:WALKER, WANITA A (ARNP)
Entity Type:Individual
Prefix:
First Name:WANITA
Middle Name:A
Last Name:WALKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MOB 503 MAIL STOP 2024
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6022
Mailing Address - Fax:913-588-4060
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:DEPT OF INTERNAL MEDICINE-ENDOCRINOLOGY
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25787017OtherBCBS KC
MO424736403Medicaid
KS636240OtherFIRSTGUARD
KS1005990AMedicaid
MO25787017OtherBCBS KC
KS500007380Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KS636240OtherFIRSTGUARD