Provider Demographics
NPI:1336346931
Name:WALKER, JAMES JOSEPH (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:WALKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:JOSEPH
Other - Last Name:WALKER RN PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:258 TOMPKINS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1246
Mailing Address - Country:US
Mailing Address - Phone:845-800-8842
Mailing Address - Fax:
Practice Address - Street 1:258 TOMPKINS RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1246
Practice Address - Country:US
Practice Address - Phone:845-800-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY510250163WC0200X, 163WM0705X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02172347Medicaid
NY510250OtherRN LICENSE