Provider Demographics
NPI:1457767410
Name:WALKER-BORCH, COURTNEY A (FNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:WALKER-BORCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:A
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:600 BLAIR PARK RD STE 285
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7586
Mailing Address - Country:US
Mailing Address - Phone:802-288-1140
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:1127 NORTH AVE STE 41
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408
Practice Address - Country:US
Practice Address - Phone:802-846-8100
Practice Address - Fax:802-846-8107
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0105515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT101.0105515Medicaid