Provider Demographics
NPI:1316275480
Name:WALKER, JOHNDRELL S (CNA/MA)
Entity type:Individual
Prefix:MRS
First Name:JOHNDRELL
Middle Name:S
Last Name:WALKER
Suffix:
Gender:F
Credentials:CNA/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-3347
Mailing Address - Country:US
Mailing Address - Phone:912-227-0015
Mailing Address - Fax:
Practice Address - Street 1:139 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-3347
Practice Address - Country:US
Practice Address - Phone:912-227-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL178814372600000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376K00000XNursing Service Related ProvidersNurse's Aide