Provider Demographics
NPI:1992319321
Name:WALKER, CARALINE PUTNAM (RN)
Entity type:Individual
Prefix:
First Name:CARALINE
Middle Name:PUTNAM
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 1:317 BUTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-6629
Mailing Address - Country:US
Mailing Address - Phone:601-253-4373
Mailing Address - Fax:
Practice Address - Street 1:2629 COURTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9521
Practice Address - Country:US
Practice Address - Phone:601-420-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905420363LF0000X
MS905240363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200002532Medicaid
MSF02220717OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
MS905240OtherMISSISSIPPI BOARD OF NURSING