Provider Demographics
NPI:1710092986
Name:WALKER, KATHRYN RENEE (CFNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RENEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:MS
Mailing Address - Zip Code:39117-8934
Mailing Address - Country:US
Mailing Address - Phone:601-537-3202
Mailing Address - Fax:
Practice Address - Street 1:330 N BROAD ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-3508
Practice Address - Country:US
Practice Address - Phone:601-469-4151
Practice Address - Fax:601-469-4724
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR591823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118904Medicaid
MSS69281Medicare UPIN
MS500000404Medicare PIN