Provider Demographics
NPI:1285357293
Name:WALKER, REAGAN LYNDSEY (FNP-C)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:LYNDSEY
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1178
Mailing Address - Street 2:
Mailing Address - City:ITTA BENA
Mailing Address - State:MS
Mailing Address - Zip Code:38941-0900
Mailing Address - Country:US
Mailing Address - Phone:662-588-1856
Mailing Address - Fax:
Practice Address - Street 1:609 N DAVIS AVE STE 105
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2379
Practice Address - Country:US
Practice Address - Phone:662-579-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily