Provider Demographics
NPI:1417043597
Name:WALKER, ELAINE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 E TANQUE VERDE RD
Mailing Address - Street 2:UNIT 13
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-6502
Mailing Address - Country:US
Mailing Address - Phone:520-603-1787
Mailing Address - Fax:
Practice Address - Street 1:7831 E WRIGHTSTOWN RD
Practice Address - Street 2:ST 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4344
Practice Address - Country:US
Practice Address - Phone:520-777-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004662363AM0700X
IA00001980363A00000X
ORPA153806363A00000X
AZ5303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8432775Medicaid
WAQ51378Medicare UPIN