Provider Demographics
NPI:1710058839
Name:WALKER, JAMIE L (ARNP, MN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:ARNP, MN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:MACKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, MN
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0959
Mailing Address - Country:US
Mailing Address - Phone:509-575-4084
Mailing Address - Fax:
Practice Address - Street 1:220 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3060
Practice Address - Country:US
Practice Address - Phone:509-925-9861
Practice Address - Fax:509-225-6313
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00139973163W00000X
WAAP60340233363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1710058839Medicaid
WAG8918412Medicare PIN