Provider Demographics
NPI:1265535306
Name:WALKER, KATHLEEN M (RN PWD APRN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN PWD APRN
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 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:CORNER OF SYDNEY ST & LAMONT AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-966-1171
Practice Address - Fax:423-224-1321
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPRN6989364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010149517Medicaid
3134309OtherMAGELLAN NAVIGATOR
334969OtherVALUE OPTIONS
620582605OtherINITIAL GROUP
620582605OtherCARITEN LEASE
VA010149843Medicaid
3134309OtherMAGELLAN PINNACLE
TN3904387Medicaid
620582605OtherBEECH STREET
620582605OtherCARITEN PHP PPO
620582605OtherCARITEN PHP WORKCO
620582605OtherCARITEN SENIOR PPO
620582605G5OtherUBH JOHN DEERE
3134309OtherMAGELLAN SUMMIT
TN3729687Medicaid
620582605OtherCARITEN PHP POS
620582605OtherCARITEN PHP HMO
620582605OtherCARITEN PHP WORKCO
620582605OtherCARITEN PHP HMO
620582605OtherCARITEN PHP POS