Provider Demographics
NPI:1538120415
Name:WALKER, LISA G (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
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 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:2962 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4448
Practice Address - Country:US
Practice Address - Phone:304-253-6227
Practice Address - Fax:304-253-6411
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49268363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001744715OtherMOUNTAIN STATE BCBS
WV7105241000Medicaid
WVNP14391Medicare PIN
WV7105241000Medicaid
WV001744715OtherMOUNTAIN STATE BCBS