Provider Demographics
NPI:1477171221
Name:WALKER, MATTHEW ROBERT (JD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:WALKER
Suffix:
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1439
Mailing Address - Country:US
Mailing Address - Phone:304-302-0707
Mailing Address - Fax:304-733-6486
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1439
Practice Address - Country:US
Practice Address - Phone:304-302-0707
Practice Address - Fax:304-733-6486
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant