Provider Demographics
NPI:1568909661
Name:WALKER, TAMEKA ANDREA (MSN, RN-BC, LMBT-MMC)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:ANDREA
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSN, RN-BC, LMBT-MMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 THACKERAY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7767
Mailing Address - Country:US
Mailing Address - Phone:910-261-6136
Mailing Address - Fax:
Practice Address - Street 1:3035A BOONE TRAIL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-261-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC232402163W00000X
NC16154225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse