Provider Demographics
NPI:1215799176
Name:WALKER, HEATHER JEAN (AGNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JEAN
Last Name:WALKER
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:JEAN
Other - Last Name:BROCATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1762
Mailing Address - Country:US
Mailing Address - Phone:517-212-2008
Mailing Address - Fax:517-212-9023
Practice Address - Street 1:770 KENMOOR AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8602
Practice Address - Country:US
Practice Address - Phone:616-272-3533
Practice Address - Fax:616-259-4839
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704292902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner