Provider Demographics
NPI:1427875889
Name:WALKER, REVA MARIE MACE (RN)
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:MARIE MACE
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 HIGHLAND PL
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-4554
Mailing Address - Country:US
Mailing Address - Phone:601-218-2796
Mailing Address - Fax:
Practice Address - Street 1:2007 HIGHLAND PL
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-4554
Practice Address - Country:US
Practice Address - Phone:601-218-2796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902801163WL0100X
MS901802163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant