Provider Demographics
NPI:1851391379
Name:WALKER, JUDY JEANNE (GNP-BC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:JEANNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 TANGLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2012
Mailing Address - Country:US
Mailing Address - Phone:817-926-7933
Mailing Address - Fax:
Practice Address - Street 1:1741 E BARDIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-4836
Practice Address - Country:US
Practice Address - Phone:817-852-8496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX555979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112659102Medicaid
TX8K8861Medicare PIN
R59523Medicare UPIN