Provider Demographics
NPI:1912618216
Name:WALKER-WITHERSPOON, YVETTE
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:WALKER-WITHERSPOON
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 1:2125 LAS VEGAS BLVD N APT 1094
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5890
Mailing Address - Country:US
Mailing Address - Phone:562-415-4620
Mailing Address - Fax:888-725-8902
Practice Address - Street 1:8275 S EASTERN AVE STE 119
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2544
Practice Address - Country:US
Practice Address - Phone:562-415-4620
Practice Address - Fax:888-725-8902
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner