Provider Demographics
NPI:1396731808
Name:WALKER, NORMAN LEE (PA)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:LEE
Last Name:WALKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RELAY ROAD
Mailing Address - Street 2:
Mailing Address - City:ANGOON
Mailing Address - State:AK
Mailing Address - Zip Code:99820
Mailing Address - Country:US
Mailing Address - Phone:907-788-4600
Mailing Address - Fax:907-788-4601
Practice Address - Street 1:725 RELAY ROAD
Practice Address - Street 2:
Practice Address - City:ANGOON
Practice Address - State:AK
Practice Address - Zip Code:99820
Practice Address - Country:US
Practice Address - Phone:907-788-4600
Practice Address - Fax:907-788-4601
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK771363A00000X
MT43492363A00000X
AZ3167363AM0700X
AK210208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ923484Medicaid
AZ923484Medicaid
AZ134481Medicare PIN
AZ102222Medicare PIN