Provider Demographics
NPI:1730256926
Name:WALKER, DONALD WILLIAM (MBA, FNP-C, GNP)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:WILLIAM
Last Name:WALKER
Suffix:
Gender:M
Credentials:MBA, FNP-C, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9702
Mailing Address - Country:US
Mailing Address - Phone:541-412-2000
Mailing Address - Fax:541-412-2081
Practice Address - Street 1:500 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9702
Practice Address - Country:US
Practice Address - Phone:541-412-2000
Practice Address - Fax:541-412-2081
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850025NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646940Medicaid
AR187719758Medicaid
OK200135330AMedicaid