Provider Demographics
NPI:1396343869
Name:WALKER, FALLON WATTS (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:FALLON
Middle Name:WATTS
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 624
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:SC
Mailing Address - Zip Code:29563
Mailing Address - Country:US
Mailing Address - Phone:843-759-3009
Mailing Address - Fax:
Practice Address - Street 1:401 E. 3RD AVE.
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:SC
Practice Address - Zip Code:29563
Practice Address - Country:US
Practice Address - Phone:843-759-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC211954163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse