Provider Demographics
NPI:1922386218
Name:WALKER, SONIA LESLIE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:LESLIE
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:LESLIE
Other - Last Name:MCFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3855 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5105
Mailing Address - Country:US
Mailing Address - Phone:601-366-9447
Mailing Address - Fax:601-366-9790
Practice Address - Street 1:3855 AZALEA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5105
Practice Address - Country:US
Practice Address - Phone:601-366-9447
Practice Address - Fax:601-366-9790
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867644363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08208312Medicaid