Individual
JACQUELINE L WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1850 E PARK AVE STE 112, STATE COLLEGE, PA 16803-6706
(800) 243-1455
Mailing address
P.O. BOX 858, MC A410, HERSHEY, PA 17033-0858
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
01018
WV
363A00000X
Physician Assistant
Primary
MA054312
PA
363AS0400X
Surgical Physician Assistant
MA054312
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1031923630002
—
PA
Enumeration date
10/05/2006
Last updated
12/15/2021
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