Provider Demographics
NPI:1629601638
Name:WALKER, TARA NICHOLE (MSN APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:NICHOLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSN APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SHOEMAKER RD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-6749
Mailing Address - Country:US
Mailing Address - Phone:270-508-1447
Mailing Address - Fax:
Practice Address - Street 1:1724 KENTON STREET
Practice Address - Street 2:SUITE #1B
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1981
Practice Address - Country:US
Practice Address - Phone:270-886-8840
Practice Address - Fax:270-886-8869
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine