Provider Demographics
NPI:1497458327
Name:GORHAM, TIMIKA WALKER (LICENSE PRACTICAL)
Entity Type:Individual
Prefix:
First Name:TIMIKA
Middle Name:WALKER
Last Name:GORHAM
Suffix:
Gender:F
Credentials:LICENSE PRACTICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E ARLINGTON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5019
Mailing Address - Country:US
Mailing Address - Phone:252-353-2555
Mailing Address - Fax:252-565-0137
Practice Address - Street 1:150 E ARLINGTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5019
Practice Address - Country:US
Practice Address - Phone:252-353-2555
Practice Address - Fax:252-565-0137
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92226164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse