Provider Demographics
NPI:1649439654
Name:WALKER, JANE ALISON (FNP-C)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ALISON
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3158
Mailing Address - Country:US
Mailing Address - Phone:731-285-4111
Mailing Address - Fax:731-285-4221
Practice Address - Street 1:1501 BRAYTON AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3158
Practice Address - Country:US
Practice Address - Phone:731-285-4111
Practice Address - Fax:731-285-4221
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13184363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN13184OtherAPN NUMBER