Provider Demographics
NPI:1285286831
Name:WALCKER, DEREK N (PMHNP)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:N
Last Name:WALCKER
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 PLUM MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5126
Mailing Address - Country:US
Mailing Address - Phone:240-723-2671
Mailing Address - Fax:
Practice Address - Street 1:5850 WATERLOO RD STE 140
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1944
Practice Address - Country:US
Practice Address - Phone:410-988-2503
Practice Address - Fax:410-343-7899
Is Sole Proprietor?:No
Enumeration Date:2019-07-14
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025119363LP0808X
MDR189093363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health