Provider Demographics
NPI:1497919401
Name:WALKER, JOHNNA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:NICOLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 CALIFORNIA ST RM 715
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1509
Mailing Address - Country:US
Mailing Address - Phone:415-668-8010
Mailing Address - Fax:415-753-2560
Practice Address - Street 1:3838 CALIFORNIA ST RM 715
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1509
Practice Address - Country:US
Practice Address - Phone:415-668-8010
Practice Address - Fax:415-752-2560
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical