Basic Information
| Provider Information | |||||||||
| NPI: | 1396731808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 HERITAGE WAY | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062578992 | ||||||||
| FaxNumber: | 4062578996 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 SUNSET BLVD | ||||||||
| Address2: | |||||||||
| City: | CONRAD | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062713211 | ||||||||
| FaxNumber: | 4062717446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 771 | AK | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 3167 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 43492 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 923484 | 05 | AZ | MEDICAID |