Provider Demographics
NPI:1558879502
Name:WALKO, JAY TARAN (RN, MSN, AGPCNP-C)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:TARAN
Last Name:WALKO
Suffix:
Gender:X
Credentials:RN, MSN, AGPCNP-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:WALKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17727 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4803
Mailing Address - Country:US
Mailing Address - Phone:503-215-9800
Mailing Address - Fax:
Practice Address - Street 1:17727 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4803
Practice Address - Country:US
Practice Address - Phone:503-215-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201243683RN163WC0200X
OR201906834NP-PP363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201248683OtherOREGON BOARD OF NURSING