Provider Demographics
NPI:1508144239
Name:WALKER, CHASTITY LEIGH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHASTITY
Middle Name:LEIGH
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-8910
Mailing Address - Country:US
Mailing Address - Phone:304-922-0043
Mailing Address - Fax:
Practice Address - Street 1:510 CHERRY ST., SUITE 301
Practice Address - Street 2:BLUEFIELD PRIMARY CARE
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701
Practice Address - Country:US
Practice Address - Phone:304-327-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily