Provider Demographics
NPI:1497855894
Name:WALKER, KATHARINE JUNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:JUNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2025 SLOAN PL
Mailing Address - Street 2:SUITE 35
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2007
Mailing Address - Country:US
Mailing Address - Phone:651-772-1572
Mailing Address - Fax:651-772-1889
Practice Address - Street 1:911 MARYLAND AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2697
Practice Address - Country:US
Practice Address - Phone:651-776-2719
Practice Address - Fax:651-771-3978
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN10094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN193417100Medicaid
MN193417100Medicaid