Provider Demographics
NPI:1861445611
Name:WALKER, ALEXANDER PEARCE (ANP)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:PEARCE
Last Name:WALKER
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2042
Mailing Address - Country:US
Mailing Address - Phone:731-660-2056
Mailing Address - Fax:731-661-9092
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2231
Practice Address - Country:US
Practice Address - Phone:731-989-0001
Practice Address - Fax:731-989-5151
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7653363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN32103OtherTLC PROVIDER NUMBER
TN3928246Medicaid
TNP00154419OtherRAILROAD MEDICARE
TNP00154419OtherRAILROAD MEDICARE
TN3928246Medicaid