Provider Demographics
NPI:1568722924
Name:WALKER, JEANNETTE
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JEANNETTE
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:9789 JOHN FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-1311
Mailing Address - Country:US
Mailing Address - Phone:850-694-1638
Mailing Address - Fax:
Practice Address - Street 1:9789 JOHN FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-1311
Practice Address - Country:US
Practice Address - Phone:850-694-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN344571164W00000X
FLOTA9309224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty