Provider Demographics
NPI:1144703497
Name:WALKER, TARA (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 COUNCIL MCCRANIE RD
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-6945
Mailing Address - Country:US
Mailing Address - Phone:478-456-8550
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL STATE HOSPITAL 2450 VINSON HWY
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31062-0001
Practice Address - Country:US
Practice Address - Phone:478-445-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201720363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health