Provider Demographics
NPI:1992141667
Name:WALKER, CASSIE M (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:M
Other - Last Name:VIDONISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-366-9898
Mailing Address - Fax:614-293-0201
Practice Address - Street 1:300 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-293-9059
Practice Address - Fax:614-293-0201
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.333071163W00000X
OHAPRN.CNP.14698363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103587Medicaid
OHH316310Medicare PIN