Provider Demographics
NPI:1669161931
Name:WALKA, AMY (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WALKA
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W LAFAYETTE SQ STE 209
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-3520
Mailing Address - Country:US
Mailing Address - Phone:706-670-9818
Mailing Address - Fax:706-236-7700
Practice Address - Street 1:102 W LAFAYETTE SQ STE 209
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-3520
Practice Address - Country:US
Practice Address - Phone:706-670-9818
Practice Address - Fax:706-236-7700
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily