Provider Demographics
NPI:1194997536
Name:WALKUP, PRISCILLA JOYCE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:JOYCE
Last Name:WALKUP
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1325
Mailing Address - Country:US
Mailing Address - Phone:304-388-9953
Mailing Address - Fax:304-388-9955
Practice Address - Street 1:3110 MACCORKLE AVE, S.E.
Practice Address - Street 2:ROOM 2042 ROBERT C. BYRD BLD
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1833
Practice Address - Country:US
Practice Address - Phone:304-388-9953
Practice Address - Fax:304-388-9955
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21258367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered