Provider Demographics
NPI:1740796168
Name:WALKER, KEAMIYAH NEISHELLE (MSN, APRN,FNP-C)
Entity type:Individual
Prefix:
First Name:KEAMIYAH
Middle Name:NEISHELLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSN, APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 RENAISSANCE DR APT 521
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1582
Mailing Address - Country:US
Mailing Address - Phone:408-912-4834
Mailing Address - Fax:
Practice Address - Street 1:121 SOTOYOME ST STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4822
Practice Address - Country:US
Practice Address - Phone:707-293-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033619363LF0000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty