Provider Demographics
NPI:1598174609
Name:WALKER, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-3835
Mailing Address - Country:US
Mailing Address - Phone:865-255-7230
Mailing Address - Fax:
Practice Address - Street 1:1800 STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-3835
Practice Address - Country:US
Practice Address - Phone:865-255-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174H00000X, 311ZA0620X
3747P1801X, 374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No174H00000XOther Service ProvidersHealth Educator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN311500000XMedicaid
TN251G00000XMedicaid
TN311ZA0620XMedicaid
TN374K00000XMedicaid
TN282J00000XMedicaid