Provider Demographics
NPI:1104149400
Name:WALKER, THANH JENNIFER (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:THANH
Middle Name:JENNIFER
Last Name:WALKER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MRS
Other - First Name:THANH
Other - Middle Name:JENNIFER
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:160 DENTAL CIR
Mailing Address - Street 2:CB 7075
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7075
Mailing Address - Country:US
Mailing Address - Phone:919-966-4743
Mailing Address - Fax:
Practice Address - Street 1:160 DENTAL CIR
Practice Address - Street 2:CB 7075
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7075
Practice Address - Country:US
Practice Address - Phone:919-966-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAPPROVAL # 5004657363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health