Provider Demographics
NPI:1417353566
Name:WALKER, PHAEDRA LYNN (APRN, DNP)
Entity Type:Individual
Prefix:DR
First Name:PHAEDRA
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9047 ALEXANDRA CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6439
Mailing Address - Country:US
Mailing Address - Phone:561-223-2735
Mailing Address - Fax:
Practice Address - Street 1:4152 W BLUE HERON BLVD STE 123
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4859
Practice Address - Country:US
Practice Address - Phone:440-844-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9319140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily