Provider Demographics
NPI:1891066734
Name:WALKER, AMANDA VIOLET (CHP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:VIOLET
Last Name:WALKER
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 1ST AVE STE. 200
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:
Practice Address - Street 1:204 BLUES AVE
Practice Address - Street 2:
Practice Address - City:HUGHES
Practice Address - State:AK
Practice Address - Zip Code:99745
Practice Address - Country:US
Practice Address - Phone:907-889-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker