Provider Demographics
NPI:1780630228
Name:CONOVER-WALKER, MARY KAY (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:CONOVER-WALKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64316
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 SHILLING CIRCLE
Practice Address - Street 2:HEALTH CENTER
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21120
Practice Address - Country:US
Practice Address - Phone:410-773-6550
Practice Address - Fax:410-773-6201
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR062679363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407469600Medicaid
MDQ44503Medicare UPIN
MD407469600Medicaid
MDKR47Q061Medicare PIN