Provider Demographics
NPI:1942243092
Name:WALKER, JOHN (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-737-1800
Mailing Address - Fax:702-737-5988
Practice Address - Street 1:4475 S EASTERN AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7826
Practice Address - Country:US
Practice Address - Phone:702-767-1800
Practice Address - Fax:702-737-5988
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005544363A00000X
UT6961599-1206363A00000X
NVPA1445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP01257617OtherRAILROAD MEDICARE
NV1942243092Medicaid
NV1942243092Medicaid