Provider Demographics
NPI:1952721615
Name:WALKER, JENNIFER LYNN (DNP, CNP, AG-ACNP, T)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:DNP, CNP, AG-ACNP, T
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:251 E HURON ST STE 15-738
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-926-9218
Mailing Address - Fax:312-926-6134
Practice Address - Street 1:251 E HURON ST STE 15-738
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-9218
Practice Address - Fax:312-926-6134
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN-TEMP2493363L00000X
ARA004062363LA2100X
IL209022483363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA004062OtherLIC
ARA004062OtherLIC