Provider Demographics
NPI:1851624985
Name:WALKER, BEVERLY CAROL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:CAROL
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 RIGGINS ROAD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5316
Mailing Address - Country:US
Mailing Address - Phone:850-877-8166
Mailing Address - Fax:850-656-9076
Practice Address - Street 1:1632 RIGGINS ROAD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5316
Practice Address - Country:US
Practice Address - Phone:850-877-8166
Practice Address - Fax:850-656-9076
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA0002702363A00000X
FLPA-2702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant