Provider Demographics
NPI:1306075098
Name:WALKER, NEVADA LEE
Entity type:Individual
Prefix:
First Name:NEVADA
Middle Name:LEE
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N BELLIN RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-2357
Mailing Address - Country:US
Mailing Address - Phone:208-524-7195
Mailing Address - Fax:
Practice Address - Street 1:316 N BELLIN RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-2357
Practice Address - Country:US
Practice Address - Phone:208-524-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist