Provider Demographics
NPI:1518450394
Name:WALKER, CHARLES D (DNP, CRNP, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:WALKER
Suffix:
Gender:M
Credentials:DNP, CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RIO PINSAQUI CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-3029
Mailing Address - Country:US
Mailing Address - Phone:251-599-3448
Mailing Address - Fax:
Practice Address - Street 1:350 REVERE ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-1633
Practice Address - Country:US
Practice Address - Phone:915-782-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
AL1-108286363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty