Provider Demographics
NPI:1912993015
Name:WALKER, DEBRA (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
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 1:111 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2434
Mailing Address - Country:US
Mailing Address - Phone:307-358-2122
Mailing Address - Fax:307-358-3432
Practice Address - Street 1:419 S WASHINGTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2951
Practice Address - Country:US
Practice Address - Phone:307-577-4220
Practice Address - Fax:307-235-0931
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY146363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311761OtherBLUE CROSS BLUE SHIELD
WYW9297Medicare ID - Type UnspecifiedWYOMING MEDICARE