Provider Demographics
NPI:1467143263
Name:WALKER, SUSAN WILSEY (AGNP-C, MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:WILSEY
Last Name:WALKER
Suffix:
Gender:F
Credentials:AGNP-C, MSN, RN
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Mailing Address - Street 1:3063 SAWYER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1652
Mailing Address - Country:US
Mailing Address - Phone:904-568-5051
Mailing Address - Fax:904-483-3902
Practice Address - Street 1:6000 POPLAR AVE STE 250
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3974
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:574-546-1999
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4012116363L00000X, 363LG0600X
FLRN2125312363LG0600X
TN34501363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner