Provider Demographics
NPI:1538833587
Name:WALKER, ANGELA SUE
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SUE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8074 TALLIHO DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4813
Mailing Address - Country:US
Mailing Address - Phone:317-287-4003
Mailing Address - Fax:888-335-0359
Practice Address - Street 1:8074 TALLIHO DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4813
Practice Address - Country:US
Practice Address - Phone:317-287-4003
Practice Address - Fax:888-335-0359
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27036491A164W00000X
171W00000X, 172V00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8932959444OtherDRIVERS LICENSE