Basic Information
| Provider Information | |||||||||
| NPI: | 1972729192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | KAE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23500 US HIGHWAY 160 | ||||||||
| Address2: | |||||||||
| City: | WALSENBURG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810899524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197385100 | ||||||||
| FaxNumber: | 7197385168 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 KANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | WALSENBURG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810891818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197385200 | ||||||||
| FaxNumber: | 7197382732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN.0004340-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 85475742 | 05 | CO | MEDICAID |