Provider Demographics
NPI:1467892729
Name:WALKER, JESSICA VAVRA (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:VAVRA
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:VAVRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:109 S NORTHSHORE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4925
Mailing Address - Country:US
Mailing Address - Phone:865-450-9253
Mailing Address - Fax:
Practice Address - Street 1:740 SOUTH LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508
Practice Address - Country:US
Practice Address - Phone:859-257-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50921208200000X, 2082S0105X
MIL2492966208600000X
TN65046208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery