Provider Demographics
NPI:1023051067
Name:WALKER, MARY J (APN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:MINYARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 6307
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-6307
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:465 ISBILL RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-2112
Practice Address - Country:US
Practice Address - Phone:865-335-0330
Practice Address - Fax:865-273-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39083231Medicaid
TNP00609752Medicare PIN
TN39083231Medicare PIN