Provider Demographics
NPI:1750346078
Name:WALKER, COLLEEN MARIE (MD)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARIE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 NANZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-899-1100
Mailing Address - Fax:502-614-6508
Practice Address - Street 1:3945 NANZ AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-899-1100
Practice Address - Fax:502-614-6508
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000023030ROtherHUMANA / NCMA
025335OtherSIHO / NCMA
1058625OtherCIGNA / NCMA
1207494OtherCHA / NCMA
50002257OtherPASSPORT / NCMA
KYP00048494OtherRAILROAD MEDICARE
2443777000OtherPASSPORT ADVANTAGE / NCMA
000000303349OtherANTHEM / NCMA
KY64079247Medicaid
KY64079247Medicaid
KY1361908Medicare PIN