Provider Demographics
NPI:1154553212
Name:WALKER, MICHAEL DOUGLAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-1650
Mailing Address - Country:US
Mailing Address - Phone:304-732-6735
Mailing Address - Fax:304-732-9218
Practice Address - Street 1:19771 COAL HERITAGE RD
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-9825
Practice Address - Country:US
Practice Address - Phone:304-436-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical