Provider Demographics
NPI:1861366502
Name:WALKER, OCTAYVIA VERTISHA
Entity type:Individual
Prefix:
First Name:OCTAYVIA
Middle Name:VERTISHA
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 STONE PARK BLVD APT 1107
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2989
Mailing Address - Country:US
Mailing Address - Phone:205-847-6027
Mailing Address - Fax:
Practice Address - Street 1:160 STONE PARK BLVD APT 1107
Practice Address - Street 2:
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-2989
Practice Address - Country:US
Practice Address - Phone:205-847-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-162634363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health