Provider Demographics
NPI:1285980136
Name:WALKER-JACKSON, DONI R (PA-C)
Entity type:Individual
Prefix:
First Name:DONI
Middle Name:R
Last Name:WALKER-JACKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 WEST 8TH STREET
Mailing Address - Street 2:DIVISION OF NEONATOLOGY 6TH FL BOX C-3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-4242
Mailing Address - Fax:904-244-4301
Practice Address - Street 1:655 W 8TH ST FL 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4242
Practice Address - Fax:904-244-4301
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12977363A00000X
PAMA061623363A00000X
FLPA9105053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128261AMedicaid
FL0071827-00Medicaid
FL0071827-00Medicaid