Provider Demographics
NPI:1184931891
Name:WALKER, JAMIE JO (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:JO
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE JO
Other - Middle Name:PETRELLA
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3417 ANISE ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-7272
Mailing Address - Country:US
Mailing Address - Phone:985-860-6535
Mailing Address - Fax:
Practice Address - Street 1:3417 ANISE ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-7272
Practice Address - Country:US
Practice Address - Phone:985-860-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant