Provider Demographics
NPI:1982821559
Name:WALKER, ANDRE (APN, CFNP)
Entity Type:Individual
Prefix:MISS
First Name:ANDRE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:APN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9006 RIVER PINE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-7196
Mailing Address - Country:US
Mailing Address - Phone:901-758-1082
Mailing Address - Fax:
Practice Address - Street 1:1300 WESLEY DRIVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116
Practice Address - Country:US
Practice Address - Phone:901-516-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341322Medicaid
TN3341322Medicaid