Provider Demographics
NPI:1396611323
Name:WALKER, AMBER RAE, (BS,BA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE,
Last Name:WALKER
Suffix:
Gender:F
Credentials:BS,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9447 W ZUNI DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-2956
Mailing Address - Country:US
Mailing Address - Phone:208-921-7045
Mailing Address - Fax:
Practice Address - Street 1:1416 E LINDEN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-5817
Practice Address - Country:US
Practice Address - Phone:208-559-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID172V00000X, 251S00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No251S00000XAgenciesCommunity/Behavioral Health