Provider Demographics
NPI:1619959350
Name:WALKER, CARRIE D (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:D
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YNHH SOUTH PAVILION, ROOM 218
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2222
Mailing Address - Fax:203-785-4580
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH SOUTH PAVILION, ROOM 218
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2222
Practice Address - Fax:203-785-4580
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970001600Medicare ID - Type Unspecified
P59340Medicare UPIN