Provider Demographics
NPI:1306276837
Name:WALKER, JACQUELINE GARALDE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:GARALDE
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:G
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:9504 SUMMER CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3930
Mailing Address - Country:US
Mailing Address - Phone:702-580-7997
Mailing Address - Fax:
Practice Address - Street 1:3750 S JONES BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2209
Practice Address - Country:US
Practice Address - Phone:702-444-7744
Practice Address - Fax:702-444-7898
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN73810163WH0200X
NV817139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid
NV1702161Medicaid