Provider Demographics
NPI:1013661289
Name:WALKER, JAMIE (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 E 550 S
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-2214
Mailing Address - Country:US
Mailing Address - Phone:765-667-3525
Mailing Address - Fax:
Practice Address - Street 1:3431 E 550 S
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-2214
Practice Address - Country:US
Practice Address - Phone:765-251-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28183077A163W00000X
INL155268163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse