Provider Demographics
NPI:1750752317
Name:WALKER, ERNEST (PA-C)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04078-0270
Mailing Address - Country:US
Mailing Address - Phone:207-725-9065
Mailing Address - Fax:207-725-9064
Practice Address - Street 1:14700 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1931
Practice Address - Country:US
Practice Address - Phone:231-547-8507
Practice Address - Fax:801-740-2847
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1568363AM0700X
MI5601008412363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical