Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP138551 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP138551 | TX |
NPI | 1043790785 |
---|---|
Provider Name | Miss Patricia Ann Walker |
First Address | Beaumont, TX 77702-1100 |
Second Address | Beaumont, TX 77702-1100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 18/10/2021 |