Provider Demographics
NPI:1134782923
Name:WALKER, TRAVERA ELIZABETH (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:TRAVERA
Middle Name:ELIZABETH
Last Name:WALKER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1032
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-1032
Mailing Address - Country:US
Mailing Address - Phone:334-447-1737
Mailing Address - Fax:
Practice Address - Street 1:807 DONNELL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-2104
Practice Address - Country:US
Practice Address - Phone:334-447-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN-9305415163W00000X
AL1-123899172V00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty