Provider Demographics
NPI:1578920211
Name:WALKER, MELISSA HOLBROOK (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:HOLBROOK
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:4108 POINT HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3012
Mailing Address - Country:US
Mailing Address - Phone:703-798-6618
Mailing Address - Fax:
Practice Address - Street 1:21785 FILIGREE COURT, SUITE 101
Practice Address - Street 2:RESTON RADIOLOGY CONSULTANTS
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:703-726-1201
Practice Address - Fax:703-858-7150
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-005183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant