Provider Demographics
NPI:1821012188
Name:WALKER, STACY L (ARNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:WALKER
Suffix:
Gender:F
Credentials:ARNP
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:641-683-0800
Mailing Address - Fax:641-683-0801
Practice Address - Street 1:522 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4231
Practice Address - Country:US
Practice Address - Phone:641-683-0800
Practice Address - Fax:641-683-0801
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA087201363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07389OtherWELLMARKIOWA
IA42146637605OtherRIVERVALLEYUHC
IAP00373615OtherRR MEDICARE
IAI4009Medicare ID - Type Unspecified
IA07389OtherWELLMARKIOWA