Basic Information
| Provider Information | |||||||||
| NPI: | 1386085090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | TEKESA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 HIGHWAY 34 E | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302651323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703043724 | ||||||||
| FaxNumber: | 7703043726 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 NEWNAN CROSSING BLVD E | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302652406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785526200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2013 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN214831 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 003137434 | 05 | GA | MEDICAID | 202I508141 | 01 | GA | MEDICARE | OTHER |