Individual
MALLORI WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
(765) 448-7611
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28180875A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71005771A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000964736
ANTHEM PROVIDER NUMBER
IN
05
—
PENDING
—
IN
Enumeration date
07/29/2015
Last updated
03/01/2021
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